Computer based business model for a statistical method for the diagnosis and treatment of BPPV

ABSTRACT

A computational statistical determination is made as to whether a person suffers from benign paroxysmal positional vertigo (BPPV) based upon answers provided by a person to questions stored in a computer. The person answers questions about the characteristics of his or her vertigo, dizziness or imbalance symptoms. Based on proprietary information about the predictive value of each question, and the relationships between the questions, the person is given a statement of the chance of his or her having BPPV which would be responsive to a head maneuver designed to clear gravity sensitive crystals from a sensitive semicircular canal (SCC) area to a less sensitive area of the inner ear. Based on this determination, the person 1) is offered for sale an apparatus for further diagnosis and an apparatus to relieve his BPPV symptoms by self-treatment or 2) he may be told to go to a healthcare provider for treatment. For self-treatment, the 1) apparatus guides the person&#39;s head positioning to allow the diagnosis of which SCC is involved (if the user provided question answers do not specifically indicate the involved SCC), and 2) guide the person&#39;s head through a head maneuver to clear the gravity sensitive crystals from the position sensitive SCC to a less sensitive area of the inner ear.

This application is a continuation-in-part of U.S. application Ser. No.09/570,002, entitled 3 Dimensional Head Apparatus,and Method For TheTreatment Of BPPV, filed on May 12, 2000, now abandoned, and thisapplication also claims the benefit of U.S. provisional application No.60/175,554, filed Jan. 11, 2000 and entitled 3 Dimensional HeadApparatus For The Treatment Of BPPV, and of U.S. provisional applicationNo. 60/161,426, filed Oct. 26, 1999, entitled 3 Dimensional Head CompassFor The Treatment Of BPPV.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The invention relates to a business based model for the diagnosis ofBPPV and the sale of devices for the diagnosis and treatment of BPPV.

2. Background

BPPV

BPPV is classically used to refer to vertigo caused by loosened otoconiacrystals in the posterior semicircular canal, the most common inner earsemicircular canal effected by loosened otoconia. To those trained inthe art, given the current understanding of the pathophysiology of BPPV,the definition of BPPV is positional vertigo caused by loosened crystalsin any of the membranous semicircular canals moving in response togravity. This more generalized definition is the one used in thisapplication. I will refer to classic posterior semicircular canalpositional vertigo as posterior BPPV or PBPPV, horizontal BPPV as HBPPVand superior semicircular canal BPPV as SBPPV.

Pathophysiology of BPPV

BPPV is caused by 1) naturally occurring calcium carbonate crystalsbecoming dislodged and falling from their normally occurring position onthe utricular macula and 2) a significant number of the crystals comingto be located in a membranous semicircular canal. When the patientplaces the head such that a particular semicircular canal is vertical,the loosened crystal(s) causes motion of the rotation sensor causing thepatient to sense vertigo. These symptoms typically resolve when theloosened crystal dissolves in the surrounding endolymphatic fluid. Ifthe loosened crystals can be moved out of the affected membranous SCCthen the patient symptoms are markedly decreased or resolved.

Incidence of BPPV

90 million Americans (42% of the population) will experience vertigosome time in their life. Approximately three million people of the 250million people in the US suffer some vertigo each year. Vertigo is themost common physician visit diagnosis in patients over 65 years of age.Seventeen percent of patients who have dizziness have benign paroxysmalpositional vertigo (BPPV). According to Fife¹, 91% of the BPPV patientswere thought to have involvement of the posterior semicircular canal, 6%involvement of the horizontal canal (7.8% according to Takegoshi²), and3% involvement of the superior (or anterior) semicircular canal. Thisapplication is directed to a new method for the diagnosis and treatmentof posterior BPPV and the treatment of benign paroxysmal positionalvertigo in the horizontal and superior semicircular canals.

Types of BPPV

Posterior BPPV

PBBPV's hallmark is vertigo when the patient moves into the affected eardownward position. The patient may also have symptoms of dizziness withlooking up, or looking down. The diagnosis is clinically confirmed byplacing the patient in the affected ear down position and watching acharacteristic rotary motion of the eyes. Although some cases of BPPVfollow head trauma, most cases have spontaneous onset of unknown origin.The natural history of positional vertigo is one of spontaneousremission, typically over 6 weeks. Recurrence is common and can lastfrom weeks to months.

One ear is usually involved but reports of up to 15% of bilateral earinvolvement have been made.

PBPPV is caused when a significant number of the loosened crystals cometo be located within the posterior semicircular canal.

PBPPV Treatments

In 1980 Brandt Daroff³ described a sequence of maneuvers in which thepatient sat on the edge of a bed/surface and laid down laterally withthe head touching the surface. After the symptoms resolved, the patientsat up and laid down on the opposite side. This was done every threehours while awake and terminated after two symptom-free days. Thismaneuver was thought to free the otolithic debris which was attached tothe cupula of the posterior semicircular canal ampulla.

Semont⁴ described what he called a Liberatory maneuver in which thepatient was rapidly moved from a sitting position to the provokingposition and kept in that position for 2-3 minutes. The patient was thenrapidly brought up through the sitting position to lie on thecontralateral side with the head turned downward 45 degrees. Thetherapist maintained the alignment of the neck and head on the body. Thepatient stayed in this second position for 5 minutes. In this secondposition the vertigo reappears and resolves. After the vertigo resolvedthe patient was slowly returned to a seated position and remainedvertical for 48 hours thereafter. This technique was thought to work bycausing the debris within the posterior semicircular canal to fall outof the canal.

Norre^(5,6,7) described the use of vestibular rehabilitation maneuversfor the treatment of BPPV. Some support for this compared to theliberatory and Epley canalith repositioning maneuvers (CRM) has beenexpressed.

Epley^(8,9) studied and refined Semont's Liberatory maneuver⁴. Epley'smaneuver is now thought to be the most effective technique for movingthe crystals out of the posterior membranous SCC (posterior canalithrepositioning maneuver).

This maneuver is defined by Epley^(8,9) as being made up of 6 positions:Start, and Positions 1, 2, 3, 4, & 5. The start position is the patientseated upright in an examination chair or on a table looking forwardwith the operator behind the patient and a mastoid oscillator applied tothe effected ear behind the ear (ipsilateral mastoid area). In position1, the patient is lying supine with the neck extended 20 degrees and thehead turned 45 degrees toward the effected ear downward position. Whilein position 1, with the neck continuing to be extended 20 degrees, thehead is turned 90 degrees toward the unaffected ear i.e. 45 degrees fromvertical in the direction of the unaffected ear into postion 2. To gofrom position 2 to position 3, the neck is kept extended 20 degrees, thepatient rolls onto the unaffected ear side of his or her body and thehead is rolled into position 3. In position three, the head (nose) ispointed 135 degrees downward, affected ear upward, from the supineposition. Keeping the head (nose) in the 135 degrees downward position,the patient is brought up to a sitting position, position 4. In position5, the head is turned forward and the chin downward 20 degrees. Eachposition is held until the induced nystagmus stops (“approachestermination”).

Harvey¹⁰ described a modification of Semont's Liberatory maneuver whichis very similar in its positions to that of Epley's canalithrepositioning maneuver.

Katsarkas¹¹ showed a modification of the Epley canalith repositioningmaneuver which he developed. In his maneuver, after the Epley position3, he extends the neck as far as is reasonably possible to allow (hebelieves) the otoconia to fall into and through the common crus portionof the posterior semicircular canal crystal removal route.

Best PBPPV Treatment Observations

One skilled in the art will recognize that the head maneuver to relievePBPPV can be done in an large (theoretically infinite) number ofpositions. That is, this maneuver could be done using the same headmovement sequence outlined by the six positions of the posterior CRPmaneuver, but it could be done such that instead of Epley positions 1, 2and 3 being 90 degrees from the previous positions, the maneuver couldbe divided into five positions each 45 degrees from the position thatpreceded it and 45 degree from the position that follows it. Ifresolution of clinical vertigo caused by each position was used as theindicator to proceed to the next position, this theoretical fiveposition maneuver would be as effective in the resolution of BPPV asEpley described in his positions 1, 2, and 3.

In the same way, those skilled in the art will recognize that thisrotation of the head could be broken up into many (theoretically aninfinite number of) positions. To one skilled in the art, the clinicaluse of a complex multipositioned maneuver is not clinically possiblebecause of the increased difficulty of correct and consistentpositioning when a multipositional maneuver is done manually. Thisdifficulty is increased further for the occasional performer, andmarkedly more for the less educated and therefore less physiologicallyunderstanding occasional performer.

Those skilled in the art recognize that the posterior CRP techniqueteaches that the Epley positions 1, and 2 are done with the patient'shead extended 20 degrees, the patient's head is supine and rotated 45degrees in the effected ear downward position (position one) and rotatestoward the unaffected ear downward (into position two) and then intoposition three with the nose pointed 135 degrees downward from supine(position three).

Theoretically the best sequence of head positions for clearing crystalsfrom the posterior SCC is the position sequence which would causeposition two to have the top of the patient's head directly downward.Positions one and three could be approximately the same as Epleyclassically described. That is, those skilled in the art will recognizethat the greater the patient's neck is extended (up to 90 degrees) inpositions one and two but especially in position two, the greater thechances that the maneuver will effectively clear the symptom-causingcrystals from the posterior SCC.

This technique of total patient rotation in the plane of the posteriorsemicircular canal has been done by Epley⁸ using a specially build chairand rotation apparatus. Lempert¹² performed a similar proceduredemonstrating the value of the Epley position one to the Epley positionthree through an Epely position two in which the patient's head waspointed directly downward.

Understanding that this head extension greater than 20 degrees and up to90 degrees makes the maneuver more effective, the current processdiscloses devices which cause the head extension up to 110 degrees.Based on this teaching, this process includes not only the currentconfiguration but devices which cause the neck to be extended greaterthan or equal to 10 degrees and up to 110 degrees in the Epley positionsone and two.

A Clinical Perspective

The posterior canalith repositioning maneuver technique is currentlyused by medical and paramedical personnel worldwide for the relief ofthe symptoms of posterior semicircular canal BPPV. The technique,although easy to do and successful after it is learned, is difficult tosuccessfully teach. The maneuver requires significant experience by theperformer to be consistently successful. Attempts to teach the maneuverto patients have been unsuccessful. The devices described hereinaccurately, consistently and inexpensively provides the user visualfeedback as to his head position at any given moment, and provides apath for the user to follow to move his head correctly through theseries of positions to accomplish the canalith repositioning maneuver.

Horizontal BPPV

Horizontal BPPV (HBPPV) was first recognized by McClure¹³ who reported 7cases with brief episodes of positional vertigo associated withhorizontal direction changing positional vertigo. Subsequent studieshave reported several variation in the type of nystagmus produced byhorizontal canal BPPV, including geotropic and ageotropic directionchanging positional nystagmus.

The clinical characteristics are 1) brief episodes of positional vertigoand 2) paroxysmal bursts of horizontal positional nystagmus and 3) lackof any other identifiable central nervous system disorder.

Geotropic horizontal direction changing paroxysmal nystagmus has beenfound in HBPPV in 90% by Nuti¹⁴, and 73% by Takegoshi² and 84% by Fife¹.Takegoshi² and reported finding BPPV in both the posterior andhorizontal semicircular canals. Nuti¹⁴, McClure¹³ and Herdman¹⁵ reportedfinding horizontal canal BPPV after canalith repositioning maneuver forrelief of PBPPV.

HBPPV Treatments

Fife¹ described three maneuver techniques for treating HBPPV.

The first maneuver was a three-quarter contralateral roll in which thepatient's head was moved in 90 degree increments away from the side withthe most intense nystagmus to achieve a 270 degree turn. This maneuverwas largely unsuccessful in the small number of patient upon whom it wasused.

The second maneuver was a single full contralateral roll. This secondmaneuver was similar to the first, except that the head was rotated theentire 360 degree turn from supine face up to supine face up, againturning toward the presumably unaffected ear.

The third maneuver was the iterative full contralateral roll. Theseexercises were performed once or twice in the clinic and the patient wasencouraged to continue these at home for 7 days or until the symptomssubsided. The head was maintained in 30 degree flexion throughout themaneuver.

Epley⁸ describes treating horizontal canal HBPPV with a 360 degree“barrel roll” away from the involved ear, keeping the horizontal canalin the earth vertical plane. To avoid dumping particles from the utricleback into the horizontal canal at the end of the procedure, the patientwas returned to upright without first moving to the straight supineposition. Epley notes that in the less agile patients, success can stillbe obtained by turning the head only 135 degrees from supine, oppositethe involved ear.

Superior BPPV Treatments

Treatment maneuver to remove loosened otoconia from the superior (oranterior) semicircular canal has only been described by one author.Epley⁸ notes “the anterior canals can usually be cleared of canaliths byusing the same positioning sequence as contralateral posteriorcanaliths”.

BPPV Diagnostic

The classic clinical description of PBPPV includes rotary nystagmus inthe effected ear down Dix-Hallpike position. Because head placement isdifficult to describe in a manner that a non medical person couldaccurately and consistently perform, and because the accuracy of whichposterior semicircular canal is not detected perfectly by thequestionnaire, there will be described a device which will guide theuser's head into the right Dix-Hallpike and the left Dix-Hallpikepositions. While in these positions the user can detect and understandwhich ear down causes the greatest amount of vertigo symptoms and hencewhich (right or left) post SCC is effected by the loosened otoconia. Theear which is effected is the ear which is initially placed downward inthe treatment maneuver. That is, the treatment maneuver iseffected-side-specific.

Based on this information and the fact that the studies of BPPV,response to head maneuvers all start from the knowledge of which ear iseffected. A device to guide the user's head into each of the two DixHallpike positions is described herein.

There are no prior art devices to this applicant's knowledge which guidethe user's head into the Dix Hallpike positions for diagnostic purposes.

Historical Diagnosis and Treatment Systems

The historical method for diagnosing and treating BPPV is for thepatient to visit his physician, be recognized as having vertigo andafter some hopeful observation for spontaneous clearing and symptomatictreatment, be referred to an otolaryngologist (ear nose and throatspecialist). This specialist would normally perform an involved historyand a physical exam, a balance test (electronystagmogram), arrive at thediagnosis of BPPV, and manually perform a posteriorcanalith-repositioning maneuver (PCRP) for the patient. This PCRP willtypically resolve 85-100% of the patients symptoms. This scenariopresumes good efficiency on the part of each of the physicians and anytechnicians involved.

Background Statistics

Questionnaire

BPPV has characteristic clinical findings that a patient can recognize.Because the clinical findings are easy to recognize, they can besuccessfully elicited by questionnaire. The results of these questionanswers can be statistically examined to determine the chance that Epleymaneuver responsive BPPV is the origin of the patient's vertigo,dizziness, or imbalance.

An original set of questions (DxQ) have been developed and thepredictive value of each of the questions and question sets has beenquantified such that the answers to the questions can be used to give a% chance that the user has BPPV.

Dizziness Handicap Inventory (DHI)¹⁶ is a series of 25 questions thathave been written, tested and established as a method of measuring thephysical, functional, and emotional effects of vertigo, dizziness orimbalance. This question series has been used to measure the severity ofthe user's dizziness symptoms.

Patient responses to the DHI and DxQ questions were collected andcorrelated with the patient responsiveness to the Epley maneuvers. Thiscorrelation yielded proprietary information about the correlation of theDHI and DxQ question answers and Epley maneuver responsiveness and 2)proprietary information about the correlation of the DHI and DxQquestion answers and posterior SCC crystal moving device success.

Computer Diagnostic History

Traditional medicine uses a medical personnel question system to elicitthe patient's history of symptoms combined with physical examination,laboratory findings and x-ray examinations to determine a diagnosis.Diagnoses are:related to treatments of varying success, and sideeffects.

With the advent of computer technology many attempts have been made toquery patients (users) and/or medical personnel for combination ofpatient history, physical examination, laboratory findings, and x-rayfindings to determine a diagnosis(DX) and to arrive at an appropriatetreatment.

No computer system which will query a patient and render a diagnosisbased on these questions have been successfully implemented. These havebeen unsuccessful because 1) the patient responses have not beensatisfactorily systematized, 2) patient are either not careful ortrained observers, 3) patient are not able to input the diagnosticallynecessary PE, lab or x-ray data, and 4) if responses can be obtainedproperly from the patient/user such that a diagnosis is established,treatment modalities typically require clearance by medical personnel.Based on these characteristics, medical diagnostic expert computersystems have been directed primarily for medical personnel use.

These medical diagnostic expert systems have not found a significantfollowing among medical personnel. The lack of success is based on thetime benefit ratio i.e. the value of the users time vs. the value to themedical personnel of the systems output. Also the users are able to workthrough the clinical problem without the computer dx (diagnostic)assistance.

There are multiple successful expert medical systems which address smallareas within medicine. This invention addresses one such area in medicaldiagnosis, the diagnosis of BPPV. This invention identifies patientswith classic BPPV within the group of patients who havevertigo/dizziness/imbalance.

Questionnaires in the Medical Literature

Many questionnaires have been used to either collect information from apatient efficiently for human mental analysis and use, or to analyze thepublic health conditions or the perspective of a community or to evenscreen those using the questionnaire for a certain condition which willthen make the human treatment of those individuals more efficient orwill detect those individuals in need of treatment by doctors such thatthey can be treated by doctors before their condition worsens i.e. makethe ultimately necessary treatment more efficient¹⁷⁻²⁵.

In 1965 Busis²⁴ published a guide to dizziness/vertigo diagnosis. Asection of that publication was devoted to disease characteristics andthe differential diagnosis of vertigo. As a portion of his history ofthe vertigo patient, Busis pointed out that he could increase theclarity of his identifying patients with ear origin dizziness bybroadening his questions to include symptoms that if present,automatically excluded the labyrinth as the sole problem. With this inmind he outlined a 4-section questionnaire. In the four sections of thequestionnaire were 11, 12, 5, and 8 questions, respectively.

In 1967 Sheehy²⁵ modified Busis' questionnaire. Sheehy's questionnairewas a 4-part questionnaire of 11, 14, 5, and 8 questions.

Both of these questionnaires were designed with the notion that thequestionnaire “facilitated the matter of history taking in the case ofthe dizzy patient”. The Busis and Sheehy questionnaires, althoughrelated directed to collecting information, were not directed tocollecting that information for computational/diagnosis reasons, butrather to collecting information for making the physician's history datacollection more efficient. These 2 questionnaires do not directly impacton the current invention.

Vertigo Diagnostic Software in the Medical Literature

There have been 3 significant vertigo diagnostic computer softwaredevelopment efforts described in the medical literature. Each of thesesystems use patient history as an information source and each attempt todiagnose the origin of vertigo.

The first software effort is a program called Vertigo²⁶⁻²⁹. The effortto build this vertigo/dizziness/imbalance diagnostic system was begun in1984 and is described in articles in 1987, 1988, and 1990. In the 1987article, 150 patients are described; in the 1990 article 200 patientsare described. The goal of this software was to provide an expertsoftware system with which otolaryngology residents could hone theirvertigo diagnostic skills and to serve as a resource for non-expertM.D.'s in the diagnosis of vertigo. The software is not intended forconsumer use. The Vertigo system uses only patient history. It is basedon Rutger's University Expert system shell using Bayesian analysistechniques combined with a knowledge database.

The Vertigo software system uses a computer generated questionnaire,deals only with differentiating diseases of the inner ear, uses patienthistory only for diagnosis, and classifies diseases identified by thesoftware as being inner ear in origin or being “other” in origin, itdoes not focus significantly on BPPV. The criteria for theclassification of these abnormalities is physician diagnosis based andnot Epley procedure response based. The system does not use a devicewhatsoever to guide the patient through the canalith repositioningmaneuver. The interface for this system is a complex interface of lists,yes/no answers, and multiple choices. From an output point of view thesystems provides multiple differential diagnoses with a statisticalprobability of the patient having each differential diagnosticpossibility.

The second vertigo diagnostic system is called ONE³⁰⁻³². ONE wasdescribed in 1993, 1995, and 1996. Although the 1993 article describesthe testing/developing of the ONE system with 173 patients, by 1996 theauthors have tested and honed their system on 564 patients. The ONEsystem is specifically designed to be an intellectual assistant to theneurotologist (inner ear dizziness expert). ONE uses patient history,clinical examination findings, as well as test findings to predict thediagnosis for the patient's dizziness or vertigo. The technique ofdetermining the correct diagnosis has to do with what the authors call“a new technique which outputs diagnosis probabilities.” It isspecifically designed to minimize wrong answers rather than specificallyidentify a correct answer. In this technique each question is weighted.Of the 142 patients clinical diagnoses analyzed by this system, 68 hadacoustic neuromas and 63 had Meniere's disease. The number of BPPVpatients in the 142 patient samples was 3. This system is clearly notoptimized for BPPV identification. The normal incidence of BPPV in 142patients is 17%, or 44 patients.

The ONE system differs from the current invention in that it is directedto neurotologists and not patients. The questions have a complex numberof options, yes/no, and multiple answers. The questions are not BPPVoriented as demonstrated by the limited number of cases of BPPV in theseries. They do not use the Epley maneuver response as a definitiveanswer for the determination of the diagnosis of BPPV, but ratherclinician diagnostic opinion. Finally, there is no device for guidingthe patient's head through a sequence of positions for accomplishing theEpley maneuver. This computer system has never been used in acommercially successful manner.

The third diagnostic program described in the medical literature iscalled Carrusel³³. Carrousel had its start in 1987 and was originallydescribed in 1990. This system's stated goal is to be a “powerfuleducational tool for students and non-expert physicians”. The Carrouselsystem is a rule based diagnostic system which queries the patient.

Carrousel and the current invention both have computer-generatedquestions. They are dissimilar in that after the patient history istaken, the Carrousel system queries for lab test results as if thesystem were coaching an otolaryngology (ear nose and throat) resident(trainee) in an educational environment or as if it were coaching anon-expert physician in how to continue the work up of the patient. Theauthors state that most end organ vestibular problems are deduced andhave no objective clinical confirmation. It would be my observation thatBPPV has clear Dix Hallpike position induced rotary nystagmus and anEpley response is a clear clinical confirmation mechanism. Furtherdissimilarities are that Carrousel is not BPPV directed. They do not usean Epley maneuver as a definitive confirmation of their positionalvertigo. There is no device for guiding the patient's head through themaneuver either patient monitored or healthcare provider monitored. TheCarrousel system is now 10 years old and has not been used commerciallysuccessfully.

2. Prior Art Patents

Several patents were found which describe systems which aresignificantly different from those described in this invention.

U.S. Pat. Nos. 5,471,382 and 5,764,923.

These patents describe a computer system in medical managed care inwhich a patient calls a medical management staff person. The patientrelates his symptoms to the computer operator. The computer operatoruses computer software utilizing “branch chain algorithm utilizing Bayestheorem” to assign a risk category without diagnosis to the patient'sproblem and to determine whether the patient needs to see a medicalstaff person and to what level of medical staff person the patientshould be directed. The patient always has the computer operator betweenhim and the computer questions. The system assigns risks and to whathuman healthcare resource the user is to be assigned. The system onlydirects the patient to one of several different human medical staffpersons. There is no device central to the method of the patent. Thepatents make no mention of vertigo or positional vertigo.

U.S. Pat. No. 5,660,176

This patient describes a computer system which can be accessed by phoneor by computer modem. The patent background makes clear that the mostfrequently seen 100 diagnoses are targeted. The user answers questionsverbally or by tone phone keyboard. This system provides medical advicebased on question answer determined common diagnosis. BPPV is not in thetop 100 diagnoses. The user is not referred for head movement treatment.There is no device offered for sale in this patented system.

Prior Art Devices

A device for sale by Medical Surgical Innovations 1 Ocean Drive,Jupiter, Fla. consists of a combination of head band and skull vibrator.

The headband is worn around the head like a tennis sweat band. It ismade from colorful neoprene and is of adjustable tension by varying thetightness of the attaching VELCRO® strip. Attached to the VELCRO® headband at the lateral side of the forehead on both sides in a planeparallel to the posterior semicircular canal on the same side is a smallclear tube filled with water and containing a small amount of sand. Thistube is intended to give the medical/paramedical person performing themaneuver for the patient, a visual feedback technique to see that theposition sequence into which they are positioning the patient will causethe sand suspended in water to move around the tube of water in the sameway that the loosened crystalline otoconia are being moved around andout of the posterior membranous semicircular canal. This device isintended for use by medical/paramedical personnel to judge the successof the positioning sequence that they are performing for the user.

The head band is used to hold a vibrator against the skull behind theeffected ear for several minutes before and during the PCRP.

The skull vibrator is a small hand held, battery operated vibratorwithin a smooth plastic case. This vibrator was held against the mastoidsurface behind the ear which was thought to be causing the BPPVsymptoms.

Two authors (Epley⁸, Lempert¹²) have reported seating the patient in adevice and completely rotating the patient in the plane of the posteriorsemicircular canal (with the capability to rotate the patient in theplane of any of the semicircular canals). These large devices representthe most accurate method of CRP for any of the canals. Ownership andself operation of these devices is certainly not feasible for the vastmajority of patient suffering from BPPV.

SUMMARY OF INVENTION

The current invention provides a new process and system for thediagnosis and sale of devices for the treatment of BPPV. The currentinvention is directed to a medical diagnosis and treatment system inwhich in one embodiment the patient goes to a computer and answers aseries of questions or is walked through the questions by anotherperson. If the question answers indicate that the user has BPPV of oneof the SCC's, he is offered for sale or provided devices which 1) helpin the diagnosis of which SCC is involved by the loosened crystals and2) allows him to perform a head maneuver to move the loosened crystalsout of the involved SCC. The user could be instructed to go to aprovider of care for treatment of his BPPV. The two devices whichperform diagnosis and treatment could be sold or used separately.

In another embodiment, the user could use the diagnostic questions topurchase the diagnostic portion of the device. With the diagnosticdevice findings entered into the question answer information, thestatistical recommendation as to whether to purchase the treatmentdevice would be more accurate.

In the preferred embodiment the user uses an electronic network(internet) to communicate with a central computer. The user answers aseries of computer presented BPPV screening questions (DHI and DxQ).These questions are combined with the predictive value of each questionanswer and question set answer. Rule based decision making can be usedor added to the statistical question analysis. The calculated chancethat the user has Epley maneuver responsive BPPV is shared with theuser.

BRIEF DESCRIPTION OF DRAWINGS Device

FIGS. 1, 2, 3, 4, and 5 depict a vertically and horizontally oriented,buoyancy neutral inner sphere upon which has been printed a series ofposition bull's eyes. Each position bull's eye is connected to the nextby a path printed upon the sphere. An outer clear plastic sphere has asighting marking upon it.

FIGS. 6, 7, and 8 depict a tube like device to hold the first componentshown in FIGS. 1, 2, 3, 4, and 5 such that the first component is heldat the focal length of the lens shown in FIGS. 6, 7, and 8.

FIGS. 9 and 10 depict the combination of the first component (FIGS.1-5), and the second component (FIGS. 6-8) and a device, the thirdcomponent for securing the first and second components over the eye ofthe user.

Treatment

PBPPV

FIGS. 11-17 depict the inner sphere surface location of the threeposition bull's eye markings which when put within the outer spheretarget marking will indicate that the user's head is correctlypositioned through the sequence of positions necessary to cause loosenedcrystalline otoconia debris to fall out of the posterior semicircularcanal and into the utricle.

HBPPV

FIGS. 18-24 depict the inner sphere surface location of the fourposition bull's eye markings which when put within the outer spheretarget marking will indicate that the user's head is correctlypositioned through the sequence of positions necessary to cause loosenedcrystalline otoconia debris to fall out of the horizontal semicircularcanal and into the utricle.

SBPPV

The inner sphere position bull's eye locations are the same for thetreatment of posterior SCC BPPV and superior SCC BPPV. In left superiorSCC BPPV treatment, the right posterior SCC BPPV first component andtreatment sequence is used. For the right superior SCC BPPV treatment,the left posterior SCC BPPV first component and treatment sequence isused. There is no different position bull's eye configuration forsuperior SCC BPPV treatment.

Diagnostic

FIGS. 25 and 26 depict the positioning of the two position bull's eyemarkings which when put within the outer sphere target marking willindicate that the user's head is in the right or left Dix Hallpikepositions used in the diagnosis of PBPPV.

Specific Descriptions of FIGS. 1-26.

FIG. 1 illustrates an outer sphere of the preferred embodiment of thedevice with a sighting marking on its exterior.

FIG. 2 is a cross-section of the device of FIG. 1 showing an innersphere supported in a liquid.

FIG. 3 illustrates a weight secured to one end of the inner sphere.

FIG. 4 illustrates a permanent magnet secured to the inside of the innersphere.

FIG. 5 illustrates position bull's eyes located on the outside of theinner sphere connected by path lines.

FIG. 6 is a side view of a cylindrical tube supporting the device ofFIGS. 1-5 at one end and a lens at the other end.

FIG. 7 illustrates an outer permanent magnet attached to the cylindricaltube of FIG. 6.

FIG. 8 illustrates the device of FIG. 7 in a different angular position.

FIGS. 9 and 10 illustrate goggles for supporting the device of FIGS. 7and 8.

FIG. 11 illustrates an inner sphere with its vertical equator.

FIG. 12 is a view of FIG. 11 as seen along the lines 12—12 thereof andillustrating the angular relationship of the three position bull's eyes.

FIG. 13 is a view similar to that of FIG. 11 illustrating the angularpositions of the three bull's eyes relative to the vertical equator.

FIG. 14 illustrates the three position bull's eyes relative to thevertical equator for the left posterior SCC BPPV treatment.

FIG. 15 is a.view of FIG. 9 as seen from lines 15—15 thereof.

FIG. 16 shows the locations of the three position bull's eyes for theright posterior SCC BPPV.

FIG. 17 is a view of FIGS. 16 as seen along lines 17—17 thereof.

FIG. 18 illustrates an inner sphere with its vertical equator.

FIG. 19 is a view of FIG. 18 as seen along the lines 19—19 thereof andillustrating the angular relationship of four position bull's eyes.

FIG. 20 is a view similar to that of FIG. 18 illustrating the angularpositions of four position bull's eyes relative to the vertical equator.

FIG. 21 shows the location of the four position bull's eyes fortreatment of right horizontal BPPV.

FIG. 22 is a view of FIG. 21 as seen along lines 22—22 thereof.

FIG. 23 shows the location of the four position bull's eyes for thetreatment of left horizontal BPPV.

FIG. 24 is a view of FIG. 23 as seen along lines 24—24 thereof.

FIG. 25 is a side view of the inner sphere showing a vertical equatorand R marking.

FIG. 26 is a view of FIG. 25 as seen along lines 26—26 thereof.

Method

BPPV Diagnostic

FIGS. 27-29 depicts the goggle guided BPPV diagnostic body positionssequence.

FIGS. 27 depicts the starting position in the device use instructions.The user is sitting on a mat with pillow behind him and goggles over hiseyes. He has the diagnostic first component in place.

FIG. 28 depicts the position “R” (right) in the diagnostic methodinstructions. The user's head is turned to the right 45 degrees and theneck is extended 20 degrees. The user can see the “R” (right) completelywithin the outer sphere sighting mark.

FIG. 29 depicts the position “L” (left) in the diagnostic methodinstructions. The user's head is turned to the left 45 degrees and theneck is extended 20 degrees. The user can see the “L” (left) completelywithin the outer sphere sighting mark.

BPPV Treatment

PBPPV

The following figures depict the goggle guided posterior SCC BPPVtreatment body positions sequence.

FIG. 30 depicts the starting position in the device use instructions.The user is sitting on a mat with pillow behind him and goggles over hiseyes. He has the right posterior SCC BPPV treatment first component inplace.

FIG. 31 depicts the position No. 1 in the right posterior BPPV treatmentdevice method instructions. The user's head is turned to the right 45degrees and the neck is extended 20 degrees. The user can see the No. 1completely within the outer sphere sighting mark.

FIG. 32 depicts the position No. 2 in the right posterior BPPV treatmentdevice method instructions. The user's head is turned to the left 45degrees and the neck.is extended 20 degrees. The user can see the No. 2completely within the outer sphere sighting mark.

FIG. 33 depicts the position No. 3 in the right posterior BPPV treatmentdevice method instructions. The user's head is turned to the left 135degrees and the neck is flexed 20 degrees. The flexure of the neck maybe less than 20 degrees, for example 10 degrees in some cases. The useris on his left side.

FIG. 34 depicts the user in position No. 4 in the right posterior BPPVtreatment device method instructions. The user's head is turned to theleft 135 degrees and the neck is flexed 20 degrees. This flexure of theneck may be less than 20 degrees, for example, 10 degrees in some cases.The user is in the crawl position.

FIG. 35 depicts the user in position No. 5 in the right posterior BPPVtreatment device method instructions. The user is in the kneelingposition looking straight ahead.

FIG. 36 depicts the starting position in the device use instructions.The user is sitting on a mat with pillow behind him and goggles over hiseyes. He has the left posterior SCC BPPV treatment first component inplace.

FIG. 37 depicts the position No. 1 in the left posterior BPPV treatmentdevice method instructions. The user's head is turned to the left 45degrees and the neck is extended 20 degrees. The user can see the No. 1completely within the outer sphere sighting mark.

FIG. 38 depicts the position No. 2 in the left posterior BPPV treatmentdevice method instructions. The user's head is turned to the right 45degrees and the neck is extended 20 degrees. The user can see the No. 2completely within the outer sphere sighting mark.

FIG. 39 depicts the position No. 3 in the left posterior BPPV treatmentdevice method instructions. The user's head is turned to the right 135degrees and the neck is flexed 20 degrees. This flexure of the neck maybe less than 20 degrees, for example, 10 degrees in some cases. The useris on his left side.

FIG. 40 depicts the user in position No. 4 in the left posterior BPPVtreatment device method instructions. The user's head is turned to theright 135 degrees and the neck is flexed 20 degrees. This flexure of theneck may be less than 20 degrees, for example, 10 degrees in some cases.The user is in the crawl position.

FIG. 41 depicts the user in position No. 5 in the left posterior BPPVtreatment device method instructions. The user is in the kneelingposition looking straight ahead.

HPBBV

The following Figures depict the goggle guided right horizontal SCC BPPVtreatment body positions sequence.

FIG. 42 depicts the starting position in the device use instructions.The user is sitting on a mat with pillow behind him and goggles over hiseyes.

FIG. 43 depicts the user lying supine with his head turned 90 degrees tothe right. He stays in this position for 30 seconds or until the vertigostops.

FIG. 44 depicts the user in a classic supine position with his neckflexed 25 degrees. He stays in this position for 30 seconds or until thevertigo stops.

FIG. 45 depicts the user turning his head 90 degrees to the left and nolonger flexing his neck. He stays in this position for 30 seconds oruntil the vertigo stops.

FIG. 46 depicts the user keeping his head in position shown in FIG. 45,while turning his body from supine to prone. He then turns his head suchthat his nose in directly downward and again flexes his neck 25 degrees.He stays in this position for 30 seconds or until the vertigo stops.

FIG. 47 depicts the user staying in a prone position and moving into thecrawl position. He stays in this position for 30 seconds or until thevertigo stops.

FIG. 48 depicts the user rising from the crawl position into a kneelingposition. He stays in this position for 30 seconds or until the vertigoresolves.

The following Figures depict the goggle guided left horizontal SCC BPPVtreatment body positions sequence.

FIG. 49 depicts the starting position in the device use instructions.The user is sitting on a mat with pillow behind him and goggles over hiseyes.

FIG. 50 depicts the user lying supine with his head turned 90 degrees tothe left. He stays in this position for 30 seconds or until the vertigostops.

FIG. 51 depicts the user in a classic supine position with his neckflexed 25 degrees. He stays in this position for 30 seconds or until thevertigo stops.

FIG. 52 depicts the user turning his head 90 degrees to the right and nolonger flexing his neck. He stays in this position for 30 seconds oruntil the vertigo stops.

FIG. 53 depicts the user keeping his head in position shown in FIG. 52,while turning his body from supine to prone. He then turns his head suchthat his nose is directly downward and again flexes his neck 25 degrees.He stays in this position for 30 seconds or until the vertigo stops.

FIG. 54 depicts the user staying in a prone position and moving into thecrawl position. He stays in this position for 30 seconds or until thevertigo stops.

FIG. 55 depicts the user rising from the crawl position into a kneelingposition. He stays in this position for 30 seconds or until the vertigoresolves.

FIGS. 56-87 illustrate more details of the embodiment of FIGS. 1-26employing a magnet in the inner sphere and an exterior magnet attachedto the device.

FIG. 56 illustrates the user in a setting position with the apparatus ofFIG. 7 attached in place to the users head.

FIG. 57 is a simplified view of FIG. 56.

FIG. 58 is a rear view of the user as seen along lines 58—58 of FIG. 57.

FIG. 59 is a view of the apparatus similar to that of FIG. 7.

FIG. 60 illustrates the sighting mark on the inner sphere of the deviceof FIG. 59.

FIG. 61 illustrates the user with his or her head inclined downward atan angle of 20 degrees relative to the horizontal with the left side ofthe head located 45 degrees relative to the vertical.

FIG. 62 is a simplified view of FIG. 61.

FIG. 63 is a view of FIG. 62 as seen along lines 63—63 thereof with theNo. 1 position of the inner sphere within the sighting mark.

FIG. 64 is a view of the apparatus of FIG. 59 when the user is in theposition of FIGS. 61-63.

FIG. 65 illustrates the No. 1 position of the inner sphere within thesighting mark.

FIG. 66 illustrates the user with his or her head inclined downward atan angle of 20 degrees relative to the horizontal with the left side ofthe head located 45 degrees relative to the vertical.

FIG. 67 is a simplified view of FIG. 66.

FIG. 68 is a view of FIG. 67 as seen along the lines 68—68 with the No.2 position of the inner sphere within the sighting mark.

FIG. 69 is a view of the apparatus of FIG. 59 when the user is in theposition of FIGS. 66-68.

FIG. 70 illustrates the No. 2 position of the inner sphere within thesighting mark.

FIG. 71 illustrates the user with his or her head inclined downward 20degrees relative to the horizontal with the head rotated clockwise 135degrees form the position of FIGS. 66-68.

FIG. 72 is a simplified view of FIG. 71.

FIG. 73 is a view of FIG. 72 as seen along the lines 73—73 thereof withthe No. 3 position of the inner sphere within the sighting mark.

FIG. 74 is a view of the apparatus of FIG. 59 when the user is in theposition of FIGS. 71-73.

FIG. 75 illustrates the No. 3 position of the inner sphere within thesighting mark.

FIGS. 76 and 77 illustrate the user in the kneeling position with his orher hands on the mat and with the head still in the position of FIGS.71-73.

FIG. 78 is a view of FIG. 77 as seen along lines 78—78 thereof with theNo. 3 position of the inner sphere within the sighting mark.

FIG. 79 is a view of the apparatus of FIG. 59 when the user is in theposition of FIGS. 76-78.

FIG. 80 illustrates the No. 3 position of the inner sphere within thesighting mark.

FIG. 81 illustrates the user in a kneeling position with his or her headin an upright position.

FIG. 82 is a simplified view of FIG. 81.

FIG. 83 illustrates the Nos. 1-3 positions of the inner sphere when theuser is in the position of FIGS. 81 and 82.

FIG. 84 is a view of the apparatus of FIG. 59 when the user is in theposition of FIGS. 81 and 82.

FIG. 85 illustrates that the user does not see the path or the Nos. 1-3positions of the inner sphere when the user is in the position of FIGS.81 and 82.

FIG. 86 illustrates the 180 degree rotation of the user head around theinner sphere for treatment of left posterior SCC BPPV.

FIG. 87 shows the complete sequence of head positions for left posteriorSCC BPPV treatment using the apparatus of FIG. 59.

FIGS. 88-93 illustrate modifications of the holding tube with the use ofadditional magnets and of the inner sphere magnet orientation.

FIG. 88 illustrates the device of FIG. 7 with additional externalmagnets secured to the tubular body with the axis of the tubular bodylocated in a horizontal position.

FIG. 89 shows the position of the device of FIG. 88 rotated 110 degreescounter clockwise from that of FIG. 88.

FIG. 90 shows the internal magnet of the internal sphere locatedparallel to the top plane of the weight.

FIG. 91 shows the device using the internal sphere of FIG. 90 with theaxis of the tubular body in a horizontal plane.

FIG. 92 shows the position of the device of FIG. 90 rotated 110 degreescounter clockwise from that of FIG. 91.

FIG. 93 is a view similar to the FIG. 92 but employing an exteriormagnet located spaced from but close to the device.

FIGS. 94-142 illustrates an entrapment device for controlling thehorizontal axis of the inner sphere.

FIG. 94 is a cross-section of the entrapment device for controlling thehorizontal axes of the inner sphere.

FIG. 95 is a view of the exterior of the device of FIG. 94 (with theentrapment cover removed) as seen from lines 95—95 thereof.

FIGS. 96-101 illustrates different entrapment slot shapes.

FIG. 102 illustrates the orientation of the entrapment protrusion ofFIG. 94.

FIG. 103 is a view of FIG. 102 as seen along lines 103—103 thereof.

FIGS. 104 and 105 illustrate the angular relationship between thesighting mark and the entrapment slot of the device of FIG. 94.

FIG. 106 is an exterior view of outer sphere the device without a covershowing the inner sphere protrusion extending through the entrapmentslot from the perspective of FIG. 95.

FIG. 107 illustrates the positions of the entrapment protrusion andinner sphere when the user rises from supine with 20 degrees neckextension to a classic supine position.

FIG. 108 illustrates the rotational position of the inner sphere whenthe user rises from a classic supine position to a sitting position.

FIG. 109 illustrates the user in a sitting position with the apparatusof FIGS. 94-108 attached in place to the users head.

FIG. 110 is a simplified view of FIG. 109.

FIG. 111 is a rear view of the user as seen along lines 111—111 of FIG.110.

FIG. 112 is a view of the apparatus similar to that of FIGS. 94-108.

FIG. 113 illustrates the sighting mark on the inner sphere of the deviceof FIGS. 94-108.

FIG. 114 illustrates the user with his or her head inclined downward atan angle of 20 degrees relative to the horizontal with the left side ofthe head located 45 degrees relative to the vertical.

FIG. 115 is a simplified view of FIG. 114.

FIG. 116 is a view of FIG. 115 seen along lines 116—116 thereof with theNo. 1 position of the inner sphere within the sighting mark.

FIG. 117 is a view of the apparatus of FIGS. 94-108 when the user is inthe position of FIGS. 114-116.

FIG. 118 illustrates the No. 1 position of the inner sphere within thesighting mark.

FIG. 119 illustrates the user with his or her head inclined downward atan angle of 20 degrees relative to the horizontal with the left side ofthe head located 45 degrees relative to the vertical.

FIG. 120 is a simplified view of FIG. 119.

FIG. 121 is a view of FIGS. 120 as seen along the lines 121—121 with theNo. 2 position of the inner sphere within the sighting mark.

FIG. 122 is a view of the apparatus of FIGS. 94-108 when the user is inthe position of FIGS. 119-120.

FIG. 123 illustrates the No. 2 position of the inner sphere in thesighting mark.

FIG. 124 illustrates the user with his or her head flexed downward 20degrees relative to the horizontal with the head rotated clockwise 135degrees from the position of FIGS. 119-121.

FIG. 125 is a simplified view of FIG. 124.

FIG. 126 is a view of FIG. 125 as seen along lines 126—126 thereof withthe No. 3 position of the inner sphere within the sighting mark.

FIG. 127 is a view of the apparatus of FIGS. 94-108 when the user is inthe position of FIGS. 124-126.

FIG. 128 illustrates the No. 3 position of the inner sphere within thesighting mark.

FIGS. 129 and 130 illustrate the user in the kneeling position with hisor her hands on the mat and with the head still in the position of FIGS.124-126.

FIG. 131 is a view of FIG. 130 as seen along the lines 131—131 thereofwith the No. 3 position of the inner sphere within the sighting mark.

FIG. 132 is a view of the apparatus of 94-108 when the user is in theposition of FIGS. 129-130.

FIG. 133 illustrates the No. 3 position of the inner sphere within thesighting mark.

FIG. 134 illustrates the user in a kneeling position with his or herhead in an upright position.

FIG. 135 is a simplified view of FIG. 134.

FIGS. 136 and 137 illustrate inner sphere component orientation as theuser approaches upright in FIGS. 134 and 135.

FIGS. 138 and 139 illustrate inner sphere component orientation as theuser assumes the upright position in FIGS. 134 and 135.

FIGS. 139 and 140 illustrate that the user does not see the path or theNos. 1-3 positions of the inner sphere when the user is in the positionof FIGS. 134 and 135.

FIG. 141 illustrates the 180 degree rotation of the users head aroundthe inner sphere axis perpendicular to the plane defined by the positionbull's eyes for treatment of left posterior SCC BPPV.

FIG. 142 illustrates the 180 degree rotation about the axisperpendicular to the plane defined by the position bull's eye andillustrates that although the axis moves during the rotation maneuver,its orientation is unchanged in II-V.

FIG. 142 shows the compete sequence of head positions for left posteriorSCC BPPV treatment using the apparatus of FIG. 94-108.

FIGS. 143 and 144 are views of the internal sphere similar to that ofFIGS. 11 and 12.

FIGS. 145-149 illustrate other sphere markings.

FIGS. 145-149 are views of the internal sphere similar to that of FIGS.13-17 but with the second position bull's eye located 30 degrees fromthe plane of the vertical equator.

FIGS. 150-165 illustrate a hanging device for use for BPPV treatment.

FIG. 150 illustrates an embodiment employing a sphere which has ahanging object.

FIG. 151 illustrates the sphere of FIG. 150 coupled to the tubularmember of FIG. 6.

FIG. 152 is a side view of a diagnostic sphere having an inside hangingobject.

FIG. 153 is a view of FIG. 152 as seen along lines 153—153 thereof.

FIG. 154 is a similar view of the sphere of FIG. 152.

FIG. 155 is a view of FIG. 154 as seen along lines 155—155 thereof.

FIG. 156 shows the L and R markings of the sphere of FIGS. 152-155.

FIG. 157 is a view of FIG. 156 as seen along lines 157—157 thereof.

FIG. 158 is a view of a treatment sphere having an inside hangingobject.

FIG. 159 is a view of FIG. 158 as seen along lines 159—159 thereof.

FIG. 160 is a view of the sphere similar to that of FIG. 158.

FIG. 161 is a view of FIG. 160 a seen along the lines 161—161.

FIG. 162 is a side view of the right post SCC BPPV treatment sphere(having an interior hanging object) showing the marking Nos. 1, 2, and3.

FIG. 163 is a view of FIG. 162 as seen along lines 163—163 thereof.

FIG. 164 is a side view of the left posterior SCC BPPV treatment sphere(having an interior hanging object) showing the marking Nos. 1, 2, and3.

FIG. 165 is a view of FIG. 164 as seen along lines 165—165 thereof.

FIGS. 166-170 illustrate a device employing sand in a liquid containedin a toroidal shaped tube for use for BPPV treatment.

FIG. 166 illustrates a toroidal tube used in another embodiment of theinvention.

FIG. 167 is a side view of a cylindrical tube with the toroidal tube ofFIG. 166 located therein.

FIG. 168 is a top view of FIG. 167 as seen along lines 168—168 with thetoroidal tube located in a first position for use for right posteriorSCC BPPV treatment.

FIG. 169 is a top view of FIG. 167 as seen along lines 168—168 with thetoroidal located at a second position for use for left posterior SCCBPPV treatment.

FIG. 170 illustrates four quadrants of the toroidal tube of FIGS.166-169.

FIGS. 171-188 illustrate a rolling ball device for use for the treatmentof BPPV.

FIGS. 171, 172, and 173 illustrate the top and sides of the outer sphereof a rolling ball embodiment of the invention.

FIG. 172A is a partial cross-section of FIG. 171 showing the side wallsof the path with a ball on the path.

FIG. 174 illustrates the outer sphere of FIGS. 171, 172, and 173 in thecylindrical member of the device.

FIG. 175 is a side view of the diagnostic outer sphere of the rollingball embodiment.

FIG. 176 is a view of FIG. 175 as seen along lines 176—176 thereof.

FIG. 177 is a view of the diagnostic outer sphere similar to that ofFIG. 175.

FIG. 178 is a view of FIG. 177 as seen along lines 178—178 thereof.

FIG. 179 illustrate the R and L markings of the sphere of FIGS. 175-178.

FIG. 180 is a view of FIG. 179 as seen along the lines 180—180 thereof.

FIG. 181 is a side view of the treatment outer sphere of the rollingball embodiment.

FIG. 182 is a view of FIG. 181 as seen along the lines 182—182 thereof.

FIG. 183 is a view of the treatment sphere similar to that of FIG. 181.

FIG. 184 is a view of FIG. 183 as seen along lines 184—184 thereof.

FIG. 185 is a side view of the right posterior SCC BPPV treatment outersphere of the rolling ball embodiment showing the marks Nos. 1, 2, and3.

FIG. 186 is a view of FIG. 185 as seen along lines 186—186 thereof.

FIG. 187 is a side view of the left posterior SCC BPPV treatment outersphere of the rolling ball embodiment showing the marks Nos. 1, 2, and3.

FIG. 188 is a view of FIG. 187 as seen along lines 188—188 thereof.

In the above Figures, the bull's eyes 1, 2, 3, 4, R, L, are shown incircular form on the exterior of the inner spheres in all lines of sightfor purposes of clarity although in a true perspective, depending uponthe line of sight, they may not be seen as circular.

In the above Figures, many of the various planes and axes areillustrated as solid lines.

FIGS. 189-204 illustrate the hardware and software configuration of anelectronic device for use in BPPV treatment.

FIGS. 189A-189D diagram the electronic circuits for obtainingmeasurements which are a function of gravity and for operating LightEmitting Diodes for directing the patient's head movement for treatingBPPV.

FIG. 190 are electrical time traces showing the event sequence of thesystem of FIG. 189.

FIG. 191 illustrates how the rotational and declination angles aredefined.

FIG. 192 illustrates the light indicators of the five light emittingdiodes of the system of FIG. 189.

FIGS. 193A & 193B is a flow diagram of the operation segment.

FIG. 194 is a flow diagram of the computation segment.

FIG. 195 is a flow diagram of a vector selection segment.

FIG. 196 illustrates a decision model.

The RX, RY, DY, DZ connectors of FIG. 189A are connected to the RX, RY,DY, DZ connectors of FIG. 189B respectively. The 189L1 and 189L2connectors of FIG. 189B are connected to the 189L1 and 189L2 connectorsof FIGS. 189C respectively. The LED1, LED2, LED3, LED4, LED5 connectorsof FIG. 189C are connected to the LED1, LED2, LED3, LED4 connectors ofFIG. 189D respectively.

FIGS. 197A and 197B is a flow diagram of a pathfinder segment.

FIG. 198 is a flow diagram of a Dwell Test Segment.

FIGS. 199A and 199B is a flow diagram of the Dwell Time Segment.

FIG. 200 is a flow diagram of the completion segment.

FIG. 201 illustrates the goggles for the electronic embodiment.

FIG. 202 is a side view of the goggles of FIG. 201 on the head of aperson.

FIG. 203 is a top view of the goggles of FIG. 201.

FIG. 204 is a side view of the goggles illustrating more detail.

FIGS. 205A-212A illustrate the positions taken by a user to diagnoseright or left posterior semicircular canal (SCC) BPPV.

FIGS. 205B-212B indicate the LEDs that are lit up in each position ofFIGS. 205A-212A respectively.

FIGS. 213A-222A illustrate the positions taken by a user in treatingright posterior SCC BPPV.

FIGS. 213B-222B indicate the LEDs that are lit up in each position ofFIGS. 213A-222A respectively.

FIGS. 223A-230A illustrate the positions taken by a user in treatingleft SCC BPPV.

FIGS. 223B-230B indicate the LEDs that are lit up in each position ofFIGS. 223A-230A respectively.

In FIGS. 205B-230B the dark outlines of the arrows and of the octagonsindicate the LEDs that are lit up.

FIGS. 231A and 231B illustrate the 90 degrees acceleration vector Ry fora sensor and timing diagrams for the 90 degrees calibration of thesensor.

FIGS. 232A and 232B illustrate the 0 degrees acceleration vector Ry fora sensor and timing diagrams for the 0 degrees calibration of thesensor.

FIGS. 233A and 233B illustrate the 270 degrees (minus ninety)acceleration vector Ry for a sensor and timing diagrams for the 270degrees calibration.

FIGS. 234A and 234B illustrate a sensor output at 45 degrees orientationfor the Ry vector.

FIGS. 235A and 235B illustrate a sensor output at 335 degreesorientation for the Ry vector.

FIGS. 236-258 are directed to another embodiment of diagnostic andtreatment devices similar to that of the devices of FIGS. 1-26 but witha marking on the inner housing or sphere and sighting marks on the outerhousing or sphere to allow an observer to monitor the user's headmovement.

FIG. 236 illustrates an outer sphere similar to that of FIG. 1 but withthe sphere of FIG. 236 having observer sighting markers thereon (but notshown in this Figure).

FIG. 237 is a cross section of the device of FIG. 236 showing an innersphere in a liquid.

FIG. 238 illustrates sighing markers of the outer sphere of FIG. 236 asused for Posterior BPPV diagnostic purposes and as seen from lines A—Aof FIG. 236.

FIG. 239 is a view similar to that of FIG. 238 but illustrating sightingmarkers of the outer sphere of FIG. 236 as used for right posterior BPPVtreatment.

FIG. 240 is a view similar to that of FIG. 238 but illustrating sightingmarkers of the outer sphere of FIG. 236 as used for left posterior BPPVtreatment.

FIG. 241 illustrates a weight secured to one end of the inner sphere.

FIG. 242 illustrates a permanent magnet secured to the inside of theinner sphere.

FIG. 243 illustrates position bull's eyes located on the outside of theinner spheres of FIGS. 237, 241, and 242.

FIG. 244 is a side view of a cylindrical tube supporting one of thedevices of FIGS. 236-244 at one end and a lens at the other end.

FIG. 245 is a view similar to that of FIG. 7 but illustrating an innersphere of the type having four position bull's eyes, in place.

FIG. 246 is a view similar to that of FIG. 8 but illustrating the innersphere of FIG. 246 in place.

FIGS. 247 and 248 illustrate goggles for supporting the device of FIGS.244-246.

FIGS. 249 illustrates an inner sphere with its vertical equator.

FIG. 250 is a view of FIG. 249 as seen along lines 250—250 thereof andillustrating the angular relationship of four position bull's eyes.

FIG. 251 is a view similar to that of FIG. 13 illustrating the angularpositions of the four bull's eyes relative to the vertical equator.

FIG. 252 is another view of the inner sphere of FIGS. 249-251 fortreating left posterior SCC.

FIG. 253 is a view of the inner sphere of FIG. 252 as seen along lines253—253 thereof.

FIG. 254 is a view of an inner sphere having four position bull's eyesfor treating right posterior SCC BPPV.

FIG. 255 is a view of FIG. 254 as seen along lines 255—255 thereof.

FIG. 256 illustrates an inner sphere with its vertical equator.

FIG. 257 is a diagnostic inner sphere having a position bull's eye No. 4thereon.

FIG. 258 is a view of FIG. 257 as seen along lines 258—258 thereof.

FIG. 259 illustrates a modification of the circuit of FIGS. 189A, 189B,189C, and 189D for allowing an observer to monitor the head movement ofa user of the embodiment of FIGS. 189-204.

FIG. 260 is a schematic diagram showing an overview of the system forimplementation of the combination of the questions and proprietaryrelationship of the questions to the diagnosis of BPPV, and a deliverysystem for the device for the treatment of BPPV.

FIG. 261 is a flow chart of the system for implementation of thecombination of question, question answers, proprietary relationshipinformation and product distribution.

FIGS. 262 is a block diagram showing the components for the user to gainaccess to the diagnostic questions to determine whether the patient'ssymptoms are BPPV.

FIG. 263 is a flow diagram showing the steps performed to establishwhether the user suffers from BPPV. The Dx questions are asked of theuser. The predictive values of the questions and, the question setanswers are combined to establish the statistical chances that the usersuffers from BPPV.

FIG. 264 is a flow diagram showing the steps performed by the user topurchase a device for the treatment of his or her BPPV.

FIG. 265 is a block diagram showing the components of the centralcomputer within which the diagnosis Dx question-answers and theirproprietary values are combined to determine the users percentage chanceof having BPPV.

FIG. 266 is a block diagram showing the components necessary for thedistributor computer to receive the user purchase order and to ship thedevice to the user using the user preferred shipping method.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

The invention is directed to a new system and process for the diagnosisand treatment of BPPV. In one embodiment, diagnosis may be carried outby way of a questionnaire submitted to and answered by the patient. Ifthe answers indicate that the user has BPPV of one of the SCC, thepatient is offered for sale a device which helps in the diagnosis ofwhich SCC is involved by the loosened crystals and a device which allowsthe patient to perform a head maneuver to move the loosened crystals outof the involved SCC. The user may use the devices for self diagnosis andself treatment or go to a health provider with the devices for diagnosisand treatment of his BPPV. The devices of FIGS. 1-259 may be sold to theuser for diagnosis and treatment of BPPV.

FIGS. 1-235 disclose devices for self-diagnostic and self-treatment BPPVwhich are disclosed and claimed in U.S. patent application Ser. No.09/570,002, filed May 12, 2000. FIGS. 236-259 disclose devices which maybe used ⁽¹⁾ for self-diagnostic and self-treatment of BPPV by visualfeedback to the patient, ⁽²⁾ used for self-diagnosis and self-treatmentof BPPV by visual feedback to the patient and monitored by a health careprovider or ⁽³⁾ in one embodiment monitored only by the health careprovider for diagnosis and treatment purposes with no visual feedback tothe patient.

FIGS. 260-266 disclose a system for implementing the questionnaire andanswer procedure, the initial diagnosis procedure and the offer for saleand sale and shipping of the diagnosis and treatment devices.

Before a description of the devices of FIGS. 1-259 is made, there willbe provided a description of the statistical method for identifyingpatients who will respond to the Epley maneuver for BPPV; thequestionnaire and answer procedure; and the system of FIG. 260-266.

Statistical Techniques

The answers to the DxQ and DHI question sets were collected from a groupof patients with vertigo, dizziness or imbalance. These patients wereevaluated by a neurotologist (ear only subspecialist). Those patientswho were through to have BPPV were treated with an Epley maneuver or agoggle directed Epley maneuver. Those patients for whom the maneuverrelieved 70% or more of their vertigo symptoms within 1 month wereselected. The DxQ and DHI question answers, and the overall improvementpercents were tabulated. These data underwent statistical evaluation.

A two phase method was used to determine the best statistical method foridentifying patients who will respond to Epley maneuver treatment forBPPV. The first phase is the selection of the best set of predictorquestions from all those questions ask and the second is thedetermination of the optimal classification rule. The “step-wise linearregression” (“forward selection” strategy” was used to choose a set ofquestions from the combined questions of the DxQ and DHI question sets.Those questions were chosen that predict good response in vertigoresolution after the Epley maneuver treatment for BPPV. After selectingthe question set which predict good Epley maneuver responses, the secondphase for establishing misclassification (false positive and falsenegative) probabilities is used. The second technique is called the“leave one out cross evaluation”. Using this technique, each subjectrelated data set was classified as a good responder if the probabilityof the subject getting >=70% resolution of his symptoms using the Epleymaneuver equals alpha. The value of alpha is then varied until the rulewith the lowest misclassification probabilities is found.

Questionnaire Construction

The questionnaire shown below was administered to a group of patientswith vertigo, dizziness or imbalance. To determine the chances that auser who is suffering dizziness/vertigo/imbalance has BPPV, two questionsets were combined and administered. The first set of questions is shownbelow. These questions were designed to elicit clinical informationwhich would support or not support the possibility that the patient'ssymptoms were BPPV. The questionnaires were completed by the patientsbefore seeing the physician. Any answer oversight was solicited by staffbefore proceeding.

The use of information provided by the goggle device (for example theembodiments of FIGS. 1-26 and 236-258) in a diagnostic mode is veryhelpful. When the goggle device is used to guide the user's head intothe right and left Dix-Hallpike positions, the presence or absence ofsubjective vertigo is a very statistically important piece ofinformation. This information can be obtained by making the device salea two stage event. The first event being the sale of the device withidentification guide ball and the second event being the sale of therelief guide ball fitting for the goggle device.

Name: _(———————————————) Pt No. _(—————) Date: _(———————————————) Pleasecomplete the following questionnaire. All questions pertain to yourdizziness/imbalance. Please answer Y = Yes, S = Sometimes, N = No 1. Howold are you? (Age) _(——) Yrs. 2. Are you male or female? M  F 3. Do youhave physician diagnosed migraine Y  N headaches? a. If Y, do you havemigraine headaches before Y  S  N or during your dizziness episodes? 4.At this moment do you have better hearing Y  N in one ear than theother? a. If Y, which ear hears better, right or left? R  L 5. Does yourhearing fluctuate (get better and Y  S  N worse)? a. If Y or S, whichear fluctuates, R  L  Unknown right ear, left ear, or Unknown? 6. Howmany months have you had balance or dizziness _(——) Months problems 7.Immediately before the beginning of your Y  N symptoms did you suffer ahead blow? 8. Immediately before the beginning of your Y  N symptoms didyou have a cold? 9. Have you had loss of consciousness before, Y  Nduring or after a dizzy episode? 10. Do you have a pressure or fullfeeling in either of Y  S  N your ears when you are dizzy or imbalanced?a. If Y or S, is the fullness in the right ear, R  L  Both left ear orboth ears? 11. Are your symptoms more spinning or more Spinningimbalance? Imbalance 12. Do you have symptoms all the time? Y  N 13. Doyour symptoms go away when you lie down in Y  S  N bed? 14. When you aredizzy or imbalanced, do your symptoms Y  S  N worsen when you turn yourhead quickly? a. If Y or S, which direction causes dizziness R  L  Bothright, left or both? 15. If you lie on your back with your head turnedto Y  S  N the side for 30 seconds do you become dizzy? a. If Y or S,which direction causes dizziness, R  L  Both right, left or both? 16.When you are dizzy or imbalanced, do your symptoms Y  S  N worsen whenyou look up? 17. When you are dizzy or imbalanced, do your symptoms Y  S N worsen when you bend down? 18. When you are dizzy or imbalanced, doyour symptoms worsen Y  S  N when you straighten up from bending down?19. Are your symptoms worse at times and better at Y  N other times? 20.Are your symptoms constant? Y  N 21. When you are dizzy or imbalanced,do your symptoms Y  S  N worsen (even for a short period of time) whenyou lie down in bed? 22. When laying on your back, do you get dizzy whenY  S  N you roll to one side or the other? a. If Y or S, when you rollto the right? Y  S  N b. If Y or S, when you roll to your left? Y  S  Nc. Which side makes you more dizzy? R  L  Unknown 23. When you are dizzyor imbalanced, do your symptoms Y  S  N worsen when you sit up in bed?24. When you are dizzy or imbalanced, do you stagger Y  S  N whilewalking? a. If Y or S, do you stagger to the right, R  L  Both left orboth directions? 25. When you are dizzy or imbalanced, do your symptomsY  S  N worsen when you look down? 26. When you are dizzy or imbalanced,do your symptoms Y  S  N worsen when you stand up from sitting? 27. Areyou only dizzy when you are standing? Y  N 28. When you are dizzy orimbalanced, do your symptoms worsen Y  S  N when you stand up from alying position? 29. Do you have physician diagnosed retinal Y  Ndetachment? 30. Do you use the internet? Y  N 31. When your symptomsfirst began, were your Spinning symptoms more spinning or moreimbalance? Imbalance 32. Are you completely free of your symptoms whileY  S  N lying in bed? 33. Do your symptoms go away immediately after youY  S  N lie down in bed? The second questionnaire was the DizzinessHandicap Inventory published in the Archives of Otolaryngology¹⁶. Bothquestionnaires are administered by the methods outlined above.Characteristic responses from a patient with classic right posterior SCCBPPV would be filled out as below. Only the answer is shown. Name:_(———————————————) Pt No. _(—————) Date: _(———————————————) Pleasecomplete the following questionnaire. All questions pertain to yourdizziness/imbalance. Please answer Y = Yes, S = Sometimes, N = No 1. Howold are you? (Age)  43  Yrs. 2. Are you male or female? F 3. Do you havephysician diagnosed migraine N headaches? a. If Y, do you have migraineheadaches before or during your dizziness episodes? 4. At this moment doyou have better hearing N in one ear than the other? a. If Y, which earhears better, right or left? 5. Does your hearing fluctuate (get betterand N worse)? a. If Y or S, which ear fluctuates, right ear, left ear,or Unknown? 6. How many months have you had balance or dizziness  4 Months problems? 7. Immediately before the beginning of your N symptomsdid you suffer a head blow? 8. Immediately before the beginning of yourN symptoms did you have a cold? 9. Have you had loss of consciousnessbefore, N during or after a dizzy episode? 10. Do you have a pressure orfull feeling in either of N your ears when you are dizzy or imbalanced?a. If Y or S, is the fullness in the right ear, left ear or both ears?11. Are your symptoms more spinning or more Spinning imbalance? 12. Doyou have symptoms all the time? N 13. Do your symptoms go away when youlie down in N bed? 14. When you are dizzy or imbalanced, do yoursymptoms N worsen when you turn your head quickly? a. If Y or S, whichdirection causes dizziness right, left or both? 15. If you lie on yourback with your head turned to Y the side for 30 seconds do you becomedizzy? a. If Y or S, which direction causes dizziness, R right, left orboth? 16. When you are dizzy or imbalanced, do your symptoms S worsenwhen you look up? 17. When you are dizzy or imbalanced, do your symptomsS worsen when you bend down? 18. When you are dizzy or imbalanced, doyour symptoms S worsen when you straighten up from bending down? 19. Areyour symptoms worse at times and better at Y other times? 20. Are yoursymptoms constant? N 21. When you are dizzy or imbalanced, do yoursymptoms Y worsen (even for a short period of time) when you lie down inbed? 22. When laying on your back, do you get dizzy when Y you roll toone side or the other? a. If Y or S, when you roll to the right? Y b. IfY or S, when you roll to your left? N c. Which side makes you moredizzy? R 23. When you are dizzy or imbalanced, do your symptoms S worsenwhen you sit up in bed? 24. When you are dizzy or imbalanced, do youstagger N while walking? a. If Y or S, do you stagger to the right, leftor both directions? 25. When you are dizzy or imbalanced, do yoursymptoms S worsen when you look down? 26. When you are dizzy orimbalanced, do your symptoms S worsen when you stand up from sitting?27. Are you only dizzy when you are standing? N 28. When you are dizzyor imbalanced, do your Y symptoms worsen when you stand up from a lyingposition? 29. Do you have physician diagnosed retinal N detachment? 30.Do you use the internet? N 31. When your symptoms first began, were yourSpinning symptoms more spinning or more imbalance? 32. Are youcompletely free of your symptoms while S lying in bed? 33. Do yoursymptoms go away immediately after you N lie down in bed? Characteristicanswers from a patient who does not have BPPV are shown below: Name:_(———————————————) Pt No. _(—————) Date: _(———————————————) Pleasecomplete the following questionnaire. All questions pertain to yourdizziness/imbalance. Please answer Y = Yes, S = Sometimes, N = No 1. Howold are you? (Age)  72  Yrs. 2. Are you male or female? M 3. Do you havephysician diagnosed migraine Y headaches? a. If Y, do you have migraineheadaches before Y or during your dizziness episodes? 4. At this momentdo you have better hearing Y in one ear than the other? a. If Y, whichear hears better, right or left? L 5. Does your hearing fluctuate (getbetter and Y worse)? a. If Y or S, which ear fluctuates, L right ear,left ear, or Unknown? 6. How many months have you had balance ordizziness  4  Months problems? 7. Immediately before the beginning ofyour N symptoms did you suffer a head blow? 8. Immediately before thebeginning of your Y symptoms did you have a cold? 9. Have you had lossof consciousness before, Y during or after a dizzy episode? 10. Do youhave a pressure or full feeling in either of Y your ears when you aredizzy or imbalanced? a. If Y or S, is the fullness in the right ear, Lleft ear or both ears? 11. Are your symptoms more spinning or moreImbalance imbalance? 12. Do you have symptoms all the time? Y 13. Doyour symptoms go away when you lie down in Y bed? 14. When you are dizzyor imbalanced, do your symptoms N worsen when you turn your headquickly? a. If Y or S, which direction causes dizziness right, left orboth? 15. If you lie on your back with your head turned to N the sidefor 30 seconds do you become dizzy? a. If Y or S, which direction causesdizziness, right, left or both? 16. When you are dizzy or imbalanced, doyour symptoms N worsen when you look up? 17. When you are dizzy orimbalanced, do your symptoms N worsen when you bend down? 18. When youare dizzy or imbalanced, do your symptoms N worsen when you straightenup from bending down? 19. Are your symptoms worse at times and better atN other times? 20. Are your symptoms constant? Y 21. When you are dizzyor imbalanced, do your symptoms N worsen (even for a short period oftime) when you lie down in bed? 22. When laying on your back, do you getdizzy when N you roll to one side or the other? a. If Y or S, when youroll to the right? b. If Y or S, when you roll to your left? c. Whichside makes you more dizzy? 23. When you are dizzy or imbalanced, do yoursymptoms N worsen when you sit up in bed? 24. When you are dizzy orimbalanced, do you stagger Y while walking? a. If Y or S, do you staggerto the right, BOTH left or both directions? 25. When you are dizzy orimbalanced, do your symptoms N worsen when you look down? 26. When youare dizzy or imbalanced, do your symptoms N worsen when you stand upfrom sitting? 27. Are you only dizzy when you are standing? Y 28. Whenyou are dizzy or imbalanced, do your symptoms worsen N when you stand upfrom a lying position? 29. Do you have physician diagnosed retinal Ydetachment? 30. Do you use the internet? N 31. When your symptoms firstbegan, were your Imbalance symptoms more spinning or more imbalance? 32.Are you completely free of your symptoms while Y lying in bed? 33. Doyour symptoms go away immediately after you Y lie down in bed?

Statistical Methods

In the preferred statistical embodiment, two basic phases are used. Thefirst phase is the selection of the best set of predictor questions fromall those questions ask, and the second is the determination of theoptimal classification rule. To accomplish the first step the techniqueof “step-wise linear regression” (“forward selection” strategy) was usedto choose a set of questions from the combined questions of the DxQ andDHI question sets. Those questions were chosen that predict goodresponse in vertigo resolution after the Epley maneuver treatment forBPPV.

After selecting the best set of questions for predicting “good” Epleymaneuver response, the second phase, that of establishing the optimalclassification rule, was undertaken. Based on standard classificationtheory, classification rules of the following form were considered:

Classify the patient as a “good” Epley maneuver responder if P50 exceedsalpha, whereas P50 is “the established probability of 50% Epleyresponsive BPPV score” and that alpha is a number between zero and one.

The optimal value of alpha was chosen via the standard technique of“leave one out” cross validation. Specifically, a selection of candidatevalues of alpha (eg. 0.1, 0.2, 0.3 . . . , 0.9) were considered one at atime and for each, the cross validation estimates of the followingcriteria were obtained:

% correct=percentage correctly classified

sensitivity=percentage of good responder correctly classified

specificity=percentage of bad responders correctly identified

false positive rate=percentage of bad responders incorrectly identified

false negative rate=percentage of good responders incorrectly identified

The Table below shows such figures for the hypothetical set ofprediction questions. Given such a table, one simply selects the valueof alpha which gives the best performance on the criteria which he deemsmost important (e.g. a low false positive rate and a high percentagecorrect).

Where the question set Model #1 contains:

Q1, Q28, Q11, Q12

Cross Validation Estimates

Model Q Set Alpha % correct sens spec F+ F−#1 .20 63 53 10 38  0 .25 6050 10 38  3 .30 69 50 19 28  3 .35 73 50 22 25  3 .40 74 50 24 24  3 .5080 50 32 15 22 .60 28 60 32 15 25

In this process each question and question set is assigned a Beta valuewhich represents its positive or negative influence upon the probabilitythat the patient has Epley maneuver responsive BPPV. An intercept pointvalue is also described.

As an example:

Variables Beta(Y) Patient Response “X” Intercept Y0 = −.76 Q1 Y1 = 1.13X1 Q28 Y28 = 2.31 X28 Q12 Y12 = .71 X12 Q11 Y11 = −1.90 811

Where:

Variables are the questions.

Betas are the positive and negative relevancy of the question answer towhether or not the patient will have Epley maneuver responsive BPPV.

Patient Response “X” are the patient answers. For the above questionsthe possible answers are:

X0=1

X1=1 if Q17 answer=Age<60

=0 if Q17 answer=Age>60

X28=1 if Q34 answer=Yes

=0 if Q34 answer=Sometimes or No

X12=1 if Q12 answer=Yes

=0 if Q12 answer=No

X11=1 if Q3 answer=Spinning

=0 if Q3 answer=Imbalance

An example would be:

X1=1 (age<60)

X28=1 (Q34=yes)

X12=0 (Q12=No)

X11=0 (Q3=imbalance)

Therefore:

Z=(−0.76)(1)+(1.13)(1)+(2.31)(1)+(0.71)(0)+(−1.90)(0)

Z=2.68

Therefore ${P50} = \frac{^{z}}{( {1 + ^{z}} )}$

Where e=2.718

P50=0.935

Because of the high % correct (80%) and the low false positive rate(15%) alpha=0.5 was selected from the cross validation estimate table.

That is:

Good Epley maneuver responder will have a P50>=alpha=0.50

or

Bad Epley maneuver responder will have a P50<=alpha=0.50

Since (in this example):

P50=0.9358 which is >0.5

Then the probability that the user has BPPV which will be responsive atleast 50% responsive to the Epley maneuver is 80%, with sensitivity=50%,specificity=32%, false positive rate=30% and false negative rate=22%.

In another embodiment, the a Multivariant Adaptive Regression Spline(MARS) model is to be used. In this embodiment the more general functionis to be used to specify the predictors depending upon the portion (orregion) of the predictor space within which the subject falls.

In another embodiment, the CART (Classification and Regression Trees)methodology can be used to accomplish the two steps of the preferredstatistical embodiment but using a different methodology. The CARTtechniques constructs a diagram in the generic form (in generic termsw/three predictors V1, V2, and V3) “if V1=No. and V2=No and V3=No thenclassify as good, if V1=No and V2=No and V3=Yes then classify as poor,etc. The tree classifier is evaluated used the “leave one out crossvalidation” technique used in the preferred statistical embodiment.

In another embodiment the Fisher Liner Discriminant Function can be usedto accomplish the two steps of the preferred statistical embodiment.

In another embodiment, Neural Networks methods can be used to solve thetwo steps of the preferred statistical embodiment.

Computer System and Process

The method and system of the present invention will now be discussedwith reference to FIGS. 260-266. In a preferred embodiment the presentinvention includes a central computer, user interface, and a distributorinterface. The central computer receives inquiries from users who suffervertigo, dizziness or imbalance. The system solicits the answers to aseries of questions from the user. The invention then uses the questionanswers and proprietary question, and question set, predictive values tocomputationally calculate the percentage chance that the user has benignparoxysmal positional vertigo that will be responsive to the use of thedevice. Rule based decision making can be used or added to thestatistical methods used to determine the user's probability ofresponsive use of the device. Those users who will be responsive to thedevice are offered the opportunity to purchase the device.

DETAILED DESCRIPTION Computer Techniques

System Architecture

The system architecture of the preferred embodiment of the apparatus andmethod of the present invention is illustrated with reference to FIG.260. As shown in FIG. 260 the apparatus of this invention comprises acentral computer 941, a user computer or interface 943 and a distributorcomputer or interface 945 (collectively the “nodes”). Each node cancommunicate with or be connected to the other nodes by way of theinternet 947 using publicly switched phone network such as thoseprovided by a local telephone or regional telephone company operatingcompany. Connection may also be provided by dedicated data lines,cellular or personal communications systems (“PCS”), cable, microwave orsatellite networks.

A conventional personal computer or workstation with sufficient memoryand processing capacity may be used as the central controller 941 asshown in FIG. 265. In one embodiment it operates as a web server, bothreceiving and transmitting information. The Pentium microprocessor, suchas the 100 mHz, P54C, commonly manufactured by Intel, Inc., may be usedfor the CPU 949. This processor employs a 32-bit architecture.Equivalent processors include Motorola 120 mHz, Howell PC 604 or SunMicrosystems 166 mHz Ultra Sparc-1.

Referring to FIG. 265, the controller 941 includes the CPU 949, a RAM951, a ROM 953, a clock 955, a common port 957, and an operating system959. The data storage device 961 may include a hard disk magnetic oroptical storage unit as well as CD-ROM drive or flash memory. Datastorage device 961 contains databases used in processing of questionanswers, question predictive values, customer demographics. It includesquestion answers 963; question predictive value database 965, customerpurchase database 967, program files 969. ID number associated questionanswer database 963 maintains data anonymously on all users who havecompleted the questions. These data are stored associated with anidentification number. Every time a series of questions is offered, to auser a unique identification number is offered as well. Immediatelyafter the user indicates that all questions have been completed, at 971in FIG. 263, the unique identification number and question answers arestored into question answer database 963. The use of this uniqueidentification number allows the user to return to retrieve and reviewquestion answers either for correction of answers after furtherconsidering the question, communication with a support person, or foridentifying serial questionnaire answer sets.

The predictive value database 965 maintains proprietary data regardingthe predictive value of individual questions and sets of questions basedon the correlation of question answers in patients with a clinicaldiagnosis of BPPV from physician consulting groups and from patientresponse after treatment with the device. These proprietary predictivevalues were determined by querying a sufficient number of new dizzypatients with an original set of predictive questions and collectingtheir responses to those questions. The patients were then treated usingthe device and objectively evaluated serially after their treatment. Thepredictive value of each question was determined using standardstatistical techniques.

Customer database 967 contains information collected each time acustomer purchases the device. This database will provide systemsinformation for product return, processes, future product notifications,product recall, and other reasonable business functions.

Network interface including a modem 975 is the gateway to communicatewith users and distribution centers through respective user 943 anddistributor 945 interfaces. Conventional internal or external modems mayserve as network interface 975. Network interface 975 supports modemswith a baud rate from 1,200 to 56,000 but may combine such input into T1or T3 line if more bandwidth is required. In the preferred embodiment,the network interface is connected with the Internet and/or any of thecommercial on-line services such as America Online, CompuServe, orProdigy, allowing users access to a full range of on-line connections.Several commercial electronic mail servers include the abovefunctionality. Alternately Internet interface 975 may be configured as avoice mail interface, Web site BBS (Bulletin Board Service), orelectronic mail address.

While the above embodiment describes a single computer acting as centralcontroller 941, those skilled in the art will realize the functionalitycan be distributed over a plurality of computers. In one embodiment, acentral controller 941 is configured in a distributed architecture,wherein the databases and processor are housed in separate units orlocations. Some controllers perform the primary process functions andcontain a minimum of RAM, ROM, and a general processor. Each of thesecontrols is attached to a WAN (Wide Area Network) hub that serves as aprimary communication link with other controllers and interface devices.The WAN hub may have minimal processing capability itself, servingprimarily as a communications router. Those skilled in the art willappreciate that almost an unlimited number of controllers may besupported. This arrangement yields a more dynamic and flexible system,less prone to characteristic hardware failure, affecting the entiresystem.

FIGS. 262 and 266 disclose user interface 943 and distributor interface945. In an exemplary embodiment they are both conventional personalcomputers having an input device such as a keyboard, and/or mouse,display device, such as video monitor, a processing device such as a CPUand a network interface such as a modem. These devices interface withthe central computer 941. Alternately user interface and distributorinterface may also be voice mail systems, or other electronic or voicecommunications systems. As described further in the followingembodiments, devices such as fax machines or pagers are also suitableinterface devices.

Referring now to FIG. 262 there is disclosed the user interface 943which includes a central processor (CPU) 981, RAM 983, ROM 985, clock987, video driver 989, video monitor 991, communication port 993, inputdevice 995, modem 997, and data storage device 999. A Pentiummicroprocessor such as the 100 mHz P54C described above may be used forthe CPU 981. Clock 987 is a standard chip based clock. Modem 997 may notrequire high-speed data transfer. Data storage device 999 may be aconventional magnetic based hard disk storage unit such as manufacturedby Conner Peripherals.

Referring now to. FIG. 266 there is disclosed the distributor interface945, which includes a central processor (CPU) 1001, RAM 1003, ROM 1005,clock 1007, video driver 1009, video monitor 1011, communications port1013, input device 1015, modem 1017, and data storage device 1019. Allthese components may be identical to those described in connection withFIG. 262.

There are many commercial software applications that can enable thecommunications required by user interface 943 and distributor interface945 the primary functionality being message creation and transmission.When the central computer 941 is configured as a web server,conventional communications software such as Netscape Navigator webbrowser from Netscape Corporation may be used. The user 943 and thedistributor 945 may use the Netscape Navigator browser. The user willuse the software to receive and answer BPPV screening questions, toreceive the % chance that he has BPPV, and to send order information forthe device. The distributor will use the software to receive orderinformation and to send shipping and inventory reports for managementpurposes.

On-line Embodiment

Referring to FIG. 263, in one embodiment of the present invention,communications with the user take place via electronic network with thecentral computer 941 configured as a web server. At the web site theuser logs on to the central computer and is presented with the BPPVscreening questions 1021 of a questionnaire 1023 as describedpreviously. The questions are complete by clicking the appropriateanswer or by completing range-limited fill-in-the-blank questions. Whenall the questions have been completed and the user believes thequestions are correct, the user indicates “All Questions Correct?” Yes,at 971. At 1025, the central processor stores all question answersassociated with the assigned identification number to the questionanswer database 963. The question answers are recalled at 1027 from thequestion answer database 963. At 1029, the question predictive valuedatabase is queried and at 1031 BPPV screening proprietary questionpredictive values are recalled. At 1033, the user question answers andproprietary question predictive values are used to calculate thepercentage chance that the user has BPPV which will be helped by thedevice. At 1035, the percent chance that the device will help the useris presented to the user in a text, graphical or multi-media manner. Atthis point the user has the option to go to the catalog module at 1037of the web site. The user also has the option to move to any otherportion of the website.

Referring to FIG. 264, in the preferred embodiment, a catalog function1041 is available with graphic and/or text description of each item.Detailed information about each catalog item can be provided. The useris invited to peruse and/or select items for purchase.

A decision to purchase is made at 1043. If no purchase is desired, theuser may take path 1045 to stay at the catalog home page, other webpages, etc. If the user decides to purchase and after one or more itemsare selected, the preferred payment method is solicited.

Payment Preferences

The user selects his preferred method of payment. Preferred methodsinclude credit cards, personal checks, electronic funds transfer,digital money, etc. At Step 1047 the user transmits payment datacorresponding to his preferred method of payment to the central computer941. As indicated by Box 1047, such payment data might include a creditcard number or bank account number. These payment methods are meant tobe merely illustrative; however, as there are many equivalent methods ofpayment commonly known to the practitioner skilled in the art, which mayalso be used. As an example, if the user wants to pay by credit card,payment data would include his credit card account number, expirationdate, name of the issuing institution, and credit limit. For electronicfunds transfer, payment data includes the name of the payer's bank andhis account number.

The central computer records the payment preference method of the userand the pertinent data regarding that payment method in the customerdatabase 967. The central computer 941 contacts the credit cardclearinghouse to get an authorization number. When the authorizationnumber is received the central computer 941 updates the customerdatabase 967 to indicate that payment has been made.

Another payment method involves procedures using digital cash. Thecentral computer 941 updates the customer database 967 to indicate thatpayment has been made. This address might be an electronic mail addressif digital cash is to be transferred by electronic mail, or it could bean Internet credit card address capable of accepting an on-line transferof digital cash. This electronic delivery address is sent to the centralcontroller 941 and updates the customer database balance at 967 toindicate that payment has been made.

The practice of using digital cash protocols to effect payment is wellknown to those skilled in the art and need not be described here indetail. For reference, one skilled in the art may refer to Daniel C.Lynch and Leslie Lundquist, Digital Money; John Wylie and Sons, 1996; orSeth Godin, Presenting Digital Cash, Sams Net Publishing, 1995.

Shipping Method

The user selects his preferred method of shipping. The preferred methodsof shipping include any method of moving the product from thedistribution site to the user. It is expected that depending upon theusers severity of symptoms he may wish to pay for a more or less rapiddelivery of the device for his use. At step 1049 the user transmitsshipping information to the central computer 941 as indicated. The cost(depending upon the speed of deliver desired and the distance of theuser from the closest distribution center) of the selected shippingmethod is shown. There are multiple equivalent shipping methods andcommercial companies to perform this function commonly known to thepractitioner skilled in the art.

Total Cost

The user is presented with his total cost for the device at 1051 and theshipping method that he has chosen. At 1053, when the user approves thisamount of charge, the central computer 941 uses the payment preferencemethod to collect the indicated amount. Credit card verification; creditcard charge; and submit order are shown at 1055, 1057, and 1059respectively.

Distribution

After the satisfactory completion of the charge collection is performed,instructions are forwarded to the distribution center at 1061 to ship,by the indicated method, the items selected by the user.

Off-line Embodiment

In another embodiment of the present invention the user can communicatein an off-line manner with the central computer 941. Rather than using aweb-based server, the user can use electronic mail, telephone, faxmachine, postal mail, or other off-line communication tools.

A user may use the telephone, for example, to answer the BPPV screeningquestion set. The user calls the central computer 941 and is connectedwith an agent. The user answers the verbally relayed questions by theagent and when the question answers, entered into the computer and“questions completed” button is pushed, the agent relays the % chancesthe device will help the user. The user can then instruct the agent thathe does or does not wish to purchase the device or other items forpurchase. If the user wishes to purchase the device, the agent solicitsthe preferred payment and preferred shipping method information from theuser and the information is entered into the computer 941. After paymenthas been received by the central computer 941, shipping instructions aresent to the distribution center 945.

In an alternative embodiment the user calls the central computer 941 andis connected with a conventional Interactive Voice Response Unit (IVRU)that allows the user to enter the solicited question answers to performscreening for BPPV. The user can then either continue enteringinteractive instructions using the touch-tones of his phone to selectpayment preference and shipping method and to accept the charges relayedby the telephone IRVU system. After the information has been received,the central computer 941 instructs the distribution center to ship theindicated items by the preferred shipping method to the user.

In another embodiment the user may call the central computer 941 torequest a fax back or postal mail list of BPPV screening questions andanswer options. After the questions have been answered, the informationis delivered by fax or postal mail to the agent. The data is enteredmanually or in an automated manner into the central computer 941. Theanswered questions, the percentage chance of improvement with the deviceis provided to the user as well as a telephone number to use to orderthe device or other items for sale. The user has the option of using thetelephone number provided to call the central computer and order thedevice using IRVU or direct connection with an agent.

Description of the Diagnosis and Treatment Devices

SBPPV

The Figures depicting the treatment positions for PBPPV treatment willbe used to describe the SBPPV position sequence.

Device

The device attaches to the user's head to measure head position and togive the user visual feedback about his head position or series of headpositions.

Referring to FIGS. 1-10, the device comprises three components ormembers 300, 400, and 500.

First Component The first component 300 comprises a clear, transparent,watertight outer sphere 302 of approximately 1{fraction (12/32)} inchesinside diameter and an outside diameter of approximately 1{fraction(14/32)} inches. The outer sphere is made of a clear plastic and hasupon it a sighting marking 306. The sighting marking is a circleapproximately ⅜ inch diameter. The thickness of the line drawing thecircle is approx. {fraction (1/16)} inches thick of black or an easilyvisible color. Within this outer sphere is an inner sphere 305. Theinner sphere has an outside diameter of approximately 1{fraction(10/32)} inches. The inner sphere weight is approx. 0.04 lbs. It is tobe understood that the dimensions and specifications of the outer andinner sphere as listed above may vary. The inner sphere is suspended ina liquid 303, water in the preferred embodiment, and is buoyancyneutral. The inner sphere has a weight 320 which maintains a verticalaxis 305V in a vertical position. The inner sphere has an elongated barmagnet 390 which is a permanent magnet 390 located in the center of thesphere 305. The axis 390A of the magnet 390 is located at an angle of 20degrees relative to a horizontal axis 305H, which is perpendicular toaxis 305V. The higher end of the magnet 390 is directed toward the side305S upon which are located the position bull's eye No. 1 and No. 2identified by reference numeral 330.

The inner sphere has a numbered series of position bull's eyes 330printed upon it and a path 315 from each position bull's eye to the nextsequentially numbered position bull's eye. There are 3 position bull'seye configurations used on the inner sphere of the embodiment. The firstis a posterior BPPV treatment configuration. The second is thehorizontal BPPV treatment configuration. The third is the BPPVdiagnostic configuration. The inner spheres in these three embodimentsare identified by reference numerals 305X, 305Y, 305Z respectively.

The posterior BPPV treatment configuration is shown in FIGS. 11-17. FIG.11 shows an inner sphere 305X with the vertical equator 305VE upon it.FIG. 12 shows that in the left posterior SCC BPPV treatmentconfiguration from the user's line of sight, the position bull's eye No.1 is 45 degrees to the right of the user's line of sight (up pointingarrow at bottom of FIG. 12); position bull's eye No. 2 is 45 degrees tothe left of the user's line of sight; and the No. 3 position bull's eyeis 135 degrees to the left of the user's line of sight. As seen in FIG.13, bull's eyes No. 1 and No. 2 are 20 degrees from the verticalequator, and No. 3 is 20 degrees from the vertical equator, but in theopposite direction. These angles are determined by the equator andstraight lines extended from the center of the inner sphere 305X to theposition bull's eyes No. 1, No. 2, and No. 3. FIG. 14 illustrates theposition bull's eyes No. 1, No. 2, and No. 3 for the left posterior SCCBPPV treatment from the perspective of FIG. 11. FIG. 15 is a view ofFIG. 14 as seen along lines 15—15 thereof. FIG. 15 illustrates theposition bull's eyes No. 1, No. 2, and No. 3 for the left posterior SCCBPPV treatment configuration. The inner sphere of FIGS. 14 and 15 foruse for the left posterior SCC BPPV treatment is identified at 305XL.

FIGS. 16 and 17 show the location of position bull's eyes No. 1, No. 2,and No. 3 for the right posterior SCC BPPV treatment configuration. FIG.16 illustrate the position bull's eyes No. 1, No. 2, and No. 3 for theright posterior SCC BPPV treatment configuration from the perspective ofFIG. 11. FIG. 17 is a view of FIG. 16 as seen from lines 17—17thereofand illustrates the position bull's eyes No. 1, No. 2, and No. 3 for theright posterior SCC BPPV treatment configuration. The inner sphere ofFIGS. 16 and 17 for use for the right posterior SCC BPPV treatment isidentified at 305XR.

The horizontal BPPV treatment configuration is shown in FIGS. 18-24.FIG. 18 shows a vertical equator 305VE of an inner sphere 305Y. FIG. 19is a view of FIG. 18 as seen along lines 19—19 thereof. In FIG. 19,position bull's eyes No. 1, No. 2, No. 3, and No. 4 are at 90 degreesfrom each other. Position bull's eyes No. 1 and No. 3 are on thehorizontal equator and position bull's eyes No. 2, and No. 4 are on thevertical axis. As shown in FIG. 20, the position of bull's eyes No. 1and No. 3 are on the vertical equator, and the position of bull's eyesNos. 2 and No. 4 are 25 degrees off the vertical equator in thedirection of the top of the user's head. These angles are determined bythe equator and straight lines extending from the center of the sphere305Y to No. 2 and No. 4 bull's eyes.

The location of the position bull's eyes for the treatment of righthorizontal BPPV is shown in FIGS. 21 and 22. FIG. 22 is a side viewdepicting position bull's eye No. 3 on the vertical equator in thecenter of the sphere and immediately behind it, not directly visible, isposition bull's eye No. 1. Position bull's eye No. 2 is at the bottomand No. 4 is at the top, each 25 degrees deviated from the verticalequator toward the head of the user. FIG. 22 is a view of FIG. 21 asseen along lines 22—22 thereof illustrating the four position bull'seyes. The inner sphere of FIGS. 21 and 22 for use for the treatment ofright horizontal BPPV is identified at 305YR.

The location of the position bull's eyes for the treatment of lefthorizontal BPPV is shown in FIGS. 23 and 24. FIG. 23 is a side view ofthe inner sphere depicting the position bulls eye No. 1 on the verticalequator in the center of the sphere and immediately behind it. Notdirectly visible, is the position bull's eye No. 3. Position bull's eyeNo. 2 is at the bottom and No. 4 is at the top, each 25 degrees deviatedfrom the vertical equator toward the head of the user. FIG. 24 is a viewof FIG. 23 as seen along lines 24—24 thereof illustrating four positionbull's eye. The inner sphere of FIGS. 23 and 24 for use for thetreatment of left horizontal BPPV is identified at 305YL.

The third position bull's eye configuration is the diagnosticconfiguration of FIGS. 25 and 26. These bull's eyes are located on aninner sphere 305Z. Position bulls eye “R” is in the same position as theright posterior SCC BPPV treatment position bulls eye No. 1, FIGS. 16and 17. Position bulls eye “L” is in the same position as the rightposterior SCC BPPV treatment position bulls eye No. 2, FIGS. 16 and 17.

The second component 400 is a device which holds the first component 300at the appropriate focal distance from the lens 410. The secondcomponent is a clear or light transmitting tube 405. By being clear itallows light to penetrate and strike the sighting mark 306 and theposition bull's eye on the lens side of the inner sphere 305. The lens410 in the preferred embodiment is a lens of 20 diopter strength. A 20diopter lens is the best combination of magnification, depth of field,and width of field. The clear plastic tube 405 portion of the secondcomponent holds the lens-proximate surface of the inner sphere and theadjacent sighting marking 306 at the focal distance 407 of the lens 410.

FIG. 7 shows the first component 300 and the second component 400 joinedand in the patient upright position. FIG. 7 depicts a magnet supportsurface 413 and the external magnet 415. The magnet 390 within the innersphere 305 as well as the left posterior BPPV treatment configuration ofposition bull's eye is shown in FIG. 7. FIG. 8 shows the first andsecond components when the user is lying in the supine position with hisneck extended 20 degrees. The orientation of the inner sphere 305 can beseen to be the same in FIGS. 7 and 8. Stabilization of the vertical axisof the inner sphere 305 is accomplished by the internal weight 320within the inner sphere 305.

A permanent magnet 390 within the inner sphere 305 will orient accordingto the earth's magnetic field when no external magnet 415 is present.However, when the distancing component 400 and positioning component 300combination are used without an external magnet 415, the permanentmagnet 390 within the inner sphere 305 will be effected by ferrousmetals (such as floor support beams) in proximity to the patient. Whenthe external magnet is in place and the patient becomes supine with 20degrees neck extension, the external magnet 415 aligns with the innersphere 305 internal magnet 390 to keep the inner sphere 305 oriented inthe horizontal axis. This functions particularly well because positionbull's eye No. 1, position bull's eye No. 2 and position bull's eye No.3 define a plane, the perpendicular to which is approximately 20 degreesoff the horizontal equator.

The third component 500 of the device is shown in FIGS. 9 and 10. Thethird component 500 is a device which holds the combination of thesecond component 400 and the first component 300 in front of the eye ofthe user. The third component establishes a fixed position on the user'sskull and transmits the position of the skull through the secondcomponent and the outer sphere of the first component. The thirdcomponent is held to the head with a headband 510 which can be a singlestrap or a split strap. The headband holds the goggle-like thirdcomponent over the eyes, firmly placed against the forehead, cheek, andover the bony nasal ridge. Positioning of the second component relativeto the eye of the user is such that the central line of sight of thesecond component is approximately 32 mm lateral to the user's skullmidline and at approximately the pupillary height. The distance of thesecond component from the eye is approximately 12-15 mm.

For diagnostic purposes the outer sphere 302 will have the diagnosticinner sphere 305Z located therein supported by the liquid 303. Fortreatment purposes, four outer spheres 302 will be provided, one havinglocated therein the inner sphere 305XL supported by the liquid 303; onehaving located therein the inner sphere 305XR supported by the liquid303; one having located therein the inner sphere 305YL supported by theliquid 303; and one having located therein the inner sphere 305YRsupported by the liquid 303. Each component 500 has two eye openings500L and 500R for the left and right eyes. Each sphere combination (302,305Z), (302, 305XL), (302, 305XR), (302, 305YL), (302, 305YR) will beseparately coupled to a component 400 to form five different componentcombinations 400 (302, 305Z), 400 (302, 305XL), 400 (302, 305XR), 400(302, 305YL), 400 (302, 305YR) each of which may be removably coupled tothe left or right openings 500L or 500R of the goggles 500.

Method to Use Device.

To diagnose right posterior and semicircular canal BPPV. The user isinstructed to follow the following procedure using the device of FIGS.1-10.

The user is instructed to sit on the floor and/or mat and put thegoggles over his eyes in such a manner that the outer clear watertightsphere sighting mark 306 is clearly seen, as shown in FIG. 27. Thediagnostic first component combination 400 (302, 305Z) is in placecoupled to the desired eye opening of the goggles 400.

The user is instructed to lie supine in position “R”, FIG. 28.

The pillow is rolled lengthwise and used longitudinally under the spinefrom C5 to L1. He is instructed to place the pillow on the mat behindhim such that the pillow will be positioned under his upper thoracicspine (not under his shoulders). He is then instructed to lie backwardupon the pillow and floor. The user is now instructed to find thepositioning bull's eye “R”, FIG. 25, 26, and position it within thesighting mark. He is to stay in this position for 30 seconds or untilhis dizziness resolves.

Sit on the floor and/or mat with goggles over the eyes, FIG. 27.

The user is instructed to return to the upright sitting position andwait for his dizziness to resolve.

Lie supine in position “L”, FIG. 29.

The pillow is rolled lengthwise and placed longitudinally under thespine from C5 to L1. The user is instructed to place the pillow on themat behind him such that the pillow will be positioned under his upperthoracic spine (not under his shoulders). He is instructed to liebackward upon the pillow and floor. The user is now instructed to findthe position bull's eye “L” (FIGS. 25, 26) and position it within thesighting marker 306. He is to stay in this position for 30 seconds oruntil his dizziness resolves.

Return to the sitting position, FIG. 27.

The user is instructed to sit upright. He is instructed to remove thegoggles, wait 30 seconds or until his dizziness resolves.

The user is instructed to determine whether placing his head in theposition such that “R” is within the sighting marking causes moredizziness than placing his head in the position such that “L” is withinthe sighting mark. The position which causes the greatest symptoms ofdizziness is the ear that is affected by the posterior semicircularcanal BPPV.

Method for Posterior SCC BPPV Treatment

Treat Right Posterior SCC BPPV:

Sit on the Floor and/or mat with goggles over eyes (FIG. 30) using thecomponent combination 400 (302, 305XR).

The user is instructed to sit on the floor or on a mat and put thegoggles over his eyes in such a manner that the outer clear watertightball sighting mark 306 is clearly seen.

Lie supine in head position No. 1 (FIG. 31).

The pillow is rolled lengthwise and placed longitudinally under thespine from C5 to L1. The user is instructed to place a pillow on the matbehind him such that the pillow will be positioned under his upperthoracic spine (not under his shoulders). He then is instructed to liebackward upon the pillow and floor. The user is now instructed to findthe positioning bull's eye No. 1 (FIGS. 16, 17) and position it withinthe sighting marker (head position No. 1). He is to stay in thisposition for thirty seconds or until his dizziness resolves.

Lie Supine in head position No. 2 (FIG. 32).

The user then moves his head such that the printed path 315 on the innersphere is kept within the sighting marking and he moves his head untilthe No. 2 positioning bull's eye (FIG. 17) is seen within the sightingmarking (head position No. 2). He is instructed to stay in his positionfor thirty seconds or until the dizziness resolves.

Lie on left side with head turned downward 135 degrees (FIG. 33) (headposition No. 3).

He now is instructed to roll upon his left side and simultaneouslyfollow the printed path 315 within the target sighting marking to thepositioning bull's eye No. 3 (FIGS. 16, 17) (head position No. 3). He isinstructed to remain in this position for thirty second or until thedizziness resolves.

Roll into crawl position (FIG. 34).

The user is instructed to keep his head in the head position 3 (FIGS.16, 17) and roll toward the left side into a crawl position as shown inFIG. 34. He is instructed to remain in this position for thirty secondor until any dizziness resolves.

Come up to a kneeling position (FIG. 35).

The user is instructed to raise his torso into a kneeling position andsteady himself for thirty seconds or until the dizziness resolves.

Either repeat the procedure or remove the goggles. If the user was dizzyduring the positioning sequence, the user now is instructed to repeatthe maneuver. If there was no dizziness during the maneuver sequence;the user is instructed to stop the maneuvers and remove the goggles.

Treat Left Posterior SCC BPPV:

Sit on the floor and/or mat with goggles over eyes (FIG. 36) using thecomponent 400 (302, 305XL).

The user is instructed to sit on the floor or on a mat and put thegoggles over his eyes in such a manner that the outer clear watertightball sighting mark is clearly seen.

Lie supine in head position No. 1 (FIG. 37).

The pillow is rolled lengthwise and place longitudinally under the spinefrom C5 to L1. The user is instructed to place a pillow on the matbehind him such that the pillow will be positioned under his upperthoracic spine (not under his shoulders). He then is instructed to liebackward upon the pillow and floor. The user now is instructed to findthe positioning bull's eye No. 1 (FIGS. 14, 15) and position it withinthe sighting marker (head position No. 1). He is to stay in thisposition for thirty seconds or until his dizziness resolves.

Lie Supine in head position No. 2 (FIG. 38).

The user then moves his head such that the printed path 315 on the innersphere is kept within the sighting marking and he moves his head untilthe No. 2 positioning bull's eye (FIGS. 14, 15) is seen within thesighting marking (head position No. 2). He is instructed to stay in thisposition for thirty seconds or until the dizziness resolves.

Lie on right side with head turned downward 135 degrees (FIG. 39). Headposition No. 3.

The user now is instructed to roll upon his right side simultaneouslyfollow the printed path 315 within the target sighting marking to thepositioning bull's eye No. 3 (FIGS. 14, 15) Head position No. 3. He isinstructed to remain in this position for thirty seconds or until thedizziness resolves.

Roll into crawl position (FIG. 40).

The user is instructed to keep his head in the head position No. 3(FIGS. 14, 15) and roll toward the right side into a crawl position, asshown in FIG. 40. He is instructed to remain in this position for thirtyseconds or until any dizziness resolves, as shown in FIG. 40.

Come up to a kneeling position (FIG. 41).

The user is instructed to raise his torso into a kneeling position andsteady himself for thirty seconds or until the dizziness resolves.

Either repeat the procedure or remove the goggles. If the user was dizzyduring the positioning sequence, the user is now instructed to repeatthe maneuver. If there was no dizziness during the positioning sequence,the user is instructed to stop the maneuvers and remove the goggles.

Treat Right Horizontal Semicircular Canal BPPV.

Sit on the floor and/or mat with goggles over the eyes, FIG. 42, usingthe component combination 400 (300, 305YR).

The user is instructed to sit on the floor on a mat and put the gogglesover his eyes in such a manner that the outer clear watertight spheresighting mark is clearly seen. The right horizontal semicircular canaltreatment first component (300, 305 YR) is in place. The user is to havethe right horizontal SCC BPPV first component in place.

Lie supine in position No. 1, FIG. 43.

The user is instructed to lie backward upon the mat or floor. He isinstructed to find the position bull's eye No. 1, FIGS. 21, 22 andposition it within the sighting marker. He is to stay in this positionfor 30 seconds or until the dizziness resolves.

Lie in position No. 2. FIG. 44.

The user moves his head such that the printed path 315 on the inner ballis kept within the sighting marking and moves his head until the No. 2position bull's eye, FIGS. 21, 22, is seen within the sighting marking.He is instructed to stay in position for 30 seconds or until thedizziness resolves. This position involves flexion of the neck 25degrees while in a classic supine position.

Lie supine in position No. 3. FIG. 45.

The user now is instructed to move his head such that the printed pathon the inner ball is: kept within the sighting marking, and moves hishead until positioning bull's eye No. 3 is seen within the sightingmarking (FIGS. 21, 22). He is instructed to stay in this position for 30seconds or until the dizziness resolves.

Lying on his stomach with his head turned 180 degrees from classicsupine, FIG. 46.

The user now is instructed to roll onto his stomach, keeping thepositioning bull's eye No. 3 within the sighting marking. He isinstructed to follow the printed path within the sighting marking toposition bull's eye No. 4 (position No. 4). He is instructed to stay inthis position for 30 seconds or until the dizziness resolves. In thisposition the patient is in a classic prone position with his neck flexed25 degrees, FIG. 46.

Get into a crawl position, FIG. 47.

The user is instructed to keep his head in position No. 4 (FIGS. 21, 22)and, keeping his head in such a position that portion bull's eye No. 4remains in the sighting marking, come to a crawl position. He isinstructed to remain in this position, with his head such that positionbull's eye No. 4 remains in the sighting mark for 30 seconds or untilthe dizziness resolves.

Come up to the kneeling position, FIG. 48.

The user is instructed to raise his torso into a kneeling position andsteady himself for 30 seconds or until the dizziness resolves.

Either repeat or remove the goggles.

If the user is dizzy during the maneuver sequence, the user is nowinstructed to repeat the maneuver. If there is no dizziness during themaneuver sequence, the user is instructed to stop the maneuvers andremove the goggles.

Treat Left Horizontal Semicircular Canal BPPV.

Sit on the floor and/or mat with goggles over the eyes, FIG. 49, usingthe component combination 400 (302, 305YL).

The user is instructed to sit on the floor on a mat and put the gogglesover his eyes in such a manner that the outer clear watertight spheresighting mark is clearly seen. The user is to have the left horizontalSCC BPPV treatment first component in place.

Lie supine in position No. 1, FIG. 50.

The user is instructed to lie backward upon the mat or floor. He isinstructed to find the position bull's eye No. 1, FIGS. 23, 24 andposition it within the sighting marker. He is to stay in this positionfor 30 seconds or until the dizziness resolves.

Lie in position No. 2. FIG. 51.

The user moves his head such that the printed path on the inner ball iskept within the sighting marking and moves his head until the No. 2position bull's eye, FIGS. 23, 24, is seen within the sighting marking.He is instructed to stay in position for 30 seconds or until thedizziness resolves. This position involves flexion of the neck 25degrees while in a classic supine position.

Lie supine in position No. 3. FIG. 52.

The user now is instructed to move his head such that the printed pathon the inner ball is kept within the sighting marking, and moves hishead until positioning bull's eye No. 3 is seen within the sightingmarking (FIGS. 23, 24). He is instructed to stay in this position for 30seconds or until the dizziness resolves.

Lying on his stomach with his head turned 180 degrees from classicsupine, FIG. 53.

The user now is instructed to roll onto his stomach, keeping thepositioning bull's eye No. 3 within the sighting marking. He isinstructed to follow the printed path within the sighting marking toposition bull's eye No. 4 (position No. 4). He is instructed to stay inthis position for 30 seconds or until the dizziness resolves. In thisposition the patient is in a classic prone position with his neck flexed25 degrees, FIG. 53.

Get into a crawl position, FIG. 54.

The user is instructed to keep his head in position No. 4 (FIGS. 23, 24)and, keeping his head in such a position that position bull's eye No. 4remains in the sighting marking, come to a crawl position. He isinstructed to remain in this position, with his head in a position suchthat bull's eye No. 4 is in the sighting marking and remains in thesighting marked for 30 seconds or until the dizziness resolves.

Come up to the kneeling position, 55.

The user is instructed to raise his torso into a kneeling position andsteady himself for 30 seconds or until the dizziness resolves.

Either repeat or remove the goggles.

If the user is dizzy during the maneuver sequence, the user is nowinstructed to repeat the maneuver. If there is no dizziness during themaneuver sequence, the user is instructed to stop the maneuvers andremove the goggles.

Treat Right Superior SCC BPPV:

Sit on the Floor and/or mat with goggles over eyes (FIG. 36) using thecomponent combination 400 (302, 305XL).

The user is instructed to sit on the floor or on a mat and put thegoggles over his eyes in such a manner that the outer clear watertightball sighting mark is clearly seen. The user is to have the leftposterior SCC BPPV treatment first component in place.

Lie supine in the head position No. 1 (FIG. 37).

The pillow is rolled lengthwise and placed longitudinally under thespine from C5 to L1. The user is instructed to place a pillow on the matbehind him such that the pillow will be positioned under his upperthoracic spine (not under his shoulders). He then is instructed to liebackward upon the pillow and floor. The user now is instructed to findthe positioning bull's eye No. 1 (FIGS. 14, 15) and position it withinthe sighting marker (head position No. 1). He is to stay in thisposition for thirty seconds or until his dizziness resolves.

Lie Supine in head position number 2 (FIG. 38).

The user then moves his head such that the printed path on the innerball is kept within the sighting marking and he moves his head until theNo. 2 positioning bull's eye (FIGS. 14, 15) is seen within the sightingmarking. He is instructed to stay in this position for thirty seconds(head position No. 1) or until the dizziness resolves.

Lie on right side with head turned downward 135 degrees (FIG. 39). Headposition No. 3.

The user now is instructed to roll upon his right side andsimultaneously follow the, printed path within the target sightingmarking to the positioning bull's eye No. 3 (FIGS. 14, 15). He ininstructed to remain in this position for thirty seconds or until thedizziness resolves.

Roll into crawl position (FIG. 40).

The user is instructed to keep his head in the head position 3 (FIGS.14, 15) and roll toward the right side into a crawl position. He isinstructed to remain in this position, as shown in FIG. 40, for thirtyseconds or until any dizziness resolves.

Come up to a kneeling position (FIG. 41).

The user is instructed to raise his torso into a kneeling position andsteady himself for thirty seconds or until the dizziness resolves.

Either repeat the procedure or remove the goggles. If the user was dizzyupon going from the crawl to the kneeling positions, the user now isinstructed to repeat the maneuver. If there was no dizziness when theuser goes from the crawling to the kneeling positions, the user isinstructed to stop the maneuvers and remove the goggles.

Treat Left Superior SCC BPPV:

Sit on the Floor and/or mat with goggles over eyes (FIG. 30) using thecomponent combination 400 (302, 305XR).

The user is instructed to sit on the floor or on a mat and put thegoggles over his eyes in such a manner that the outer clear watertightball sighting mark is clearly seen. The user is to have the rightposterior SCC BPPV treatment first component in place FIG. 30.

Lie supine in head position number 1 (FIG. 31).

The pillow is rolled lengthwise and placed longitudinally under thespine from C5 to L1. The user is instructed to place a pillow on the matbehind him such that the pillow will be positioned under his upperthoracic spine (not under his shoulders). He then is instructed to liebackward upon the pillow and floor. The user now is instructed to findthe positioning bull's eye No. 1 (FIGS. 16, 17) and position it withinthe sighting marker (head position No. 1). He is to stay in thisposition for thirty seconds or until his dizziness resolves.

Lie Supine in head position number 2 (FIG. 32).

The user then moves his head such that the printed path on the innersphere is kept within the sighting marking and he moves his head untilthe No. 2 positioning bull's eye (FIGS. 16, 17) is seen within thesighting marking (head position No. 2). He is instructed to stay in thisposition for thirty seconds or until the.dizziness resolves.

Lie on left side with head turned downward 135 degrees (FIG. 33). Headposition No. 3.

The user is now instructed to roll upon his left side and simultaneouslyfollow the printed path within the target sighting marking to thepositioning bull's eye No. 3 (FIGS. 16, 17) (head position No. 3). He ininstructed to remain in this position for thirty seconds or until thedizziness resolves.

Roll into crawl position (FIG. 34).

The user is instructed to keep his head in the head position 3 (FIG. 34)and roll toward the left side into a crawl position, as shown in FIG.34. He is instructed to remain in this position for thirty seconds oruntil any dizziness resolves.

Come up to a kneeling position (FIG. 35).

The user is instructed to raise his torso into a kneeling position andsteady himself for thirty seconds or until the dizziness resolves.

Either repeat the procedure or remove goggles. If the user was dizzyupon going from the crawl to the kneeling positions, the user is nowinstructed to repeat the maneuver. If there was no dizziness when theuser goes from the crawling to the kneeling position, the user isinstructed to stop the maneuvers and remove the goggles.

Detailed description of the left posterior semicircular canal BPPVtreatment showing body positions and goggle apparatus using magnetembodiment.

Principles in Action. Reference is Made to FIGS. 56-87.

When the sighting mark has within it a position bull's eye or positionbull's eye path FIG. 65, 70, 75, 80 then the internal 390 and external415 magnets are aligned, FIGS. 64, 69, 74, 79 and they form an axis D.This axis D is in a 20 degree top of head down relationship to thehorizontal plane. The long axis of the head S in FIGS. 57, 67, 72, 77 isin a 20 degree top-of-head-down relationship with the horizontal plane.Hence axis D and axis S are parallel.

The plane defined by the position bull's eye and their path isperpendicular to the magnet axis D, FIGS. 59, 64, 69, 74, 79, 84. Thelong axis of the user's head S is parallel to the axis D. Since axis Dis parallel to axis S and since the bull's eye defined plane isperpendicular to axis D then the bull's eye defined plane isperpendicular to axis S. If the relationship between the users head andthe goggle device is constant then when the position bull's eye orposition bull's eye path is kept within the target sighting mark and thehead is rotated from position bull's eye to No. 1 to position bull's eyeNo. 3, the maneuver will be correctly completed.

One of the difficult aspects of the maneuver is to keep the head in the20-degree plane during the transition from head position 2 to headposition 3. In this transition the user goes from the lying on his backin a neck extended position to lying on his side in a neck flexed (orchin tucked) position. During this transition there is a period duringwhich the neck must be extended downward to keep the long axis of thehead downward by 20 degrees. This occurs as the user is rolling onto theshoulder opposite the ear being treated. The visual feedback isnecessary to keep the long axis of the head correctly positioned.

It is also necessary to have visual feedback for the user while theuser's head is in position 3 and the user is transitioning from the facedownward position while lying on his side head position No. 3 to thecrawl position. Maintaining the head in the same position is difficultwithout visual feedback.

FIGS. 56-60 show the user in the start position sitting up with a pillowplaced to support and elevate his back. The external magnet 415 isvertical in the same axis as the longitudinal axis S of the head, FIG.57. The user can see no markings within the target sighting mark, FIG.60. The internal magnet is centered within the inner sphere and has a20-degree angle to the horizontal. The plane defined by the positionbull's eyes is perpendicular to the internal magnet axis D.

FIGS. 61-65 show the user lying on his back with his head turned to theleft 45 degrees and his neck extended 20 degrees. In this position, FIG.61, the external magnet can be seen to be aligned with the internalmagnet, FIG. 64, and the target sighting mark has within it the positionbull's eye No. 1, FIGS. 64, 65. Whenever the target sighting mark haswithin it the plane defined by the position bull's eye, that is, has aposition bull's eye or the position bull's eye path within it, theinternal and external magnets will be aligned and the user's head willbe at a 20 degrees top-of-head-down angle to the horizontal plane. Thekey to successfully performing a successful maneuver is to maintain thishead long axis orientation during the rotation of the head in the planedefined by the position bull's eyes.

FIGS. 66-70 show the user lying on his back with his head turned to theright 45 degrees, FIGS. 66 and 67, with his neck extended 20 degrees.The user has kept the position bull's eye path within the targetsighting mark and has turned his head 90 degrees to the right, FIGS. 66,67 such that he has the position bull's eye No. 2 in the target sightingmark, FIG. 70.

FIG. 71-75 show that the user has rolled 90 degrees from head positionNo. 2 to head position No. 3, FIG. 73, onto the right side and hasturned his face downward at a 45 degree angle to horizontal, FIG. 71. Hehas also gone from a neck extended, FIGS. 66, 67 to a neck flexed (chintucked toward chest) position, FIGS. 71, 72. This requires that the usernot only transition from neck extension to neck flexion but do so whilerolling onto his right shoulder. The user must, in the middle of thistransition, bend his neck laterally to maintain the top-of-head downwardangle relative to the horizontal plane. This is accomplished by keepingthe bull's eye path within the target sighting mark during the movement.

FIGS. 76-80 show that the user has maintained the same head position,FIGS. 73, 74, 75, 78, 79, 80 and has moved from a right side downposition, FIGS. 71, 72, to the crawl position, FIGS. 76, 77.

FIGS. 81-85 show the user having moved from the crawl to the kneelingpositions, FIGS. 81, 82. The external magnet is returned to the verticalposition, FIG. 84. The user no longer sees any position bull's eye inthe target sighting mark, FIG. 85. The user is now looking at theopposite side of the inner sphere, FIG. 84, than the side which he sawin the start sitting position, FIG. 59.

FIG. 86 shows the 180 degree rotation of the user's head around theinterior magnet axis D seen end on for treatment of left posterior SCCBPPV.

FIG. 87 shows a view of the complete sequence of head positions for leftposterior SCC BPPV treatment from the point of view in line with themagnet axis D, 20 degrees top-of-head-down from the horizontal. In FIG.871 the back of the user's head in the sitting position is seen. In FIG.8711 the user lies down with 20 degree neck extension allowing themagnet axis D to be seen end on and turns his head 45 degrees to theleft (head position No. 1). He then maintains the neck extension andturns his head 90 degrees to the right to head position No. 2, FIG.87III. He turns his head to the right another 90 degrees whilemaintaining the top of the head down 20 degrees bending his necklaterally 20 degrees, rolls onto this right shoulder and flexes his neck(chin toward chest) 20 degrees, FIG. 81IV. Maintaining the head positionNo. 3, FIG. 87IV, the user moves into a crawl position, FIG. 87V. Theuser moves from a crawl position to the kneeling position, FIG. 87VI. Inthe kneeling position, FIG. 87V, the axis of the inner sphere magnet 390is seen end on with the position bull's eye visible.

Other Embodiments First Component

Inner Ball Structure Variations

Horizontal Axis Magnetic Control

As in the previously discussed embodiment this device attaches to theuser's head to reflect head position and to give the user visualfeedback about this head position or series of head positions.

In the previously discussed embodiment the external magnet 415 provideshorizontal axis orientation when the patient lies down and especiallywhen the patient lies supine with 20 degrees of neck extension, FIG. 8.When the patient is sitting, FIG. 88, the external magnet isapproximately perpendicular to the axis of the inner sphere internalmagnet 390, FIG. 88. In order to keep the internal magnet 390 orientedapproximately in the horizontal plane in the sitting position,additional magnets can be placed on the second component 405. By keepingthe inner sphere oriented in the position shown in FIG. 88 in thesitting position, instructions can be presented to the user on thesurface of the inner sphere 305. This additional magnet or magnetsorient the inner sphere 305, in the sitting position, by creating ahorizontal axis magnetic entrapment system. FIG. 88 shows the secondcomponent 400 and first component 300 with additional magnets 416R and416L attached to both sides of the clear plastic tube 405B of the secondcomponent 400. These additional magnets ensure that the axis of theinner sphere magnet 390 and hence the inner sphere is oriented as shownin FIG. 88 relative to axis of the tube 405 when the user is in thesitting position. When the user lies in a supine position with 20degrees of neck extension, as shown in FIG. 89, the magnets 416 R, 416 Lbecome perpendicular to the long axis of the inner sphere magnet 390. Insuch a configuration the magnets 416 R and 416 L cease to significantlyaffect the inner sphere magnet 390, but the external magnet 415 rotatesinto direct alignment with the axis of the inner sphere magnet 390 suchthat the external magnet 415 keeps the inner sphere oriented for theposterior semicircular canal treatment maneuver.

In another embodiment, as shown in FIG. 90, the axis of the inner spheremagnet 390 can be located parallel to the flat surface of the weight 320such that it will be oriented in the horizontal plane (horizontal at alltimes). When the first component inner sphere 305 is fitted with ahorizontal internal magnet 390 and is attached to the second component400 as shown in FIG. 91, the internal magnet 390 is optimally aligned tobe affected by the earth's magnetic field. The device can be used whenno surrounding ferrous objects are within 15 feet of the user to disruptthe inner sphere magnet orientation with the earth's magnet field.Additionally this configuration allows any three dimensional headposition to be determined based on the configuration of positionalbull's eyes printed on the outer surface of the inner sphere.

In another embodiment, as shown in FIG. 93, when the inner sphere of thefirst component is configured with horizontal permanent magnet 390, butthe device is intended to be used in the presence of ferrous objects, anexternal magnet 492 not attached to the device but located close 61 tothe device and which is strong enough to create a magnetic field thatcan effect magnet 390, can be effective in correctly orienting theinternal magnet 390 and hence the inner sphere 305.

Horizontal Axis Control by Entrapment

In another embodiment, horizontal axis control of the inner sphere 305can occur by an entrapment device. This device attaches to the user'shead to measure head position and to give the user visual feedback abouthis head position or series of head positions.

FIG. 94 shows an inner sphere 305 within a clear, transparent,water-tight outer sphere configuration 302 for the first component 300,with the inner sphere 305 being buoyancy neutral, suspended in a fluid(water) 303 being enclosed in a watertight outer sphere 302. In thisembodiment, the inner sphere 305 has an entrapment protrusion 340 whichis fixed to the inner sphere 305 and extends radially outward therefrom.The entrapment protrusion 340 fits within an entrapment slot 350.Entrapment slot 350 and entrapment protrusion 340 are covered by anentrapment cover 355, which keeps the outer sphere watertight. FIG. 96shows a cutaway view of the entrapment slot 350 in one configuration.Entrapment slot configurations are shown in FIGS. 96-101. Theorientation of the entrapment protrusion 340 is shown in FIG. 94. Theentrapment protrusion extends outward approximately 4 mm along a linewhich begins at the center of the inner sphere and is elevated 20degrees relative to the horizontal axis. A line extending perpendicularthrough the plane formed by the position bull's eyes No. 1, No. 2, andNo. 3 extends approximately in the line of the entrapment protrusion340.

The entrapment slot 350 has an arcuate length 350L which defines a 45degree angle relative to the center of the outer sphere 302. That is((pi)(d)/8) is approximately the best entrapment slot length; wherepi=3.1416, d=diameter of the sphere in which the entrapment slot 350 isplaced. FIG. 104 shows the orientation of the center of the sightingmark 306 and the center of the entrapment slot 350 when the patient islying in a supine position with his neck extended 20 degrees and thesagittal plane of his skull perpendicular to the horizon. (In FIG. 104the entrapment slot 350 is shown extending 22.5 degrees on each side ofthe protrusion 340). In this position, the entrapment protrusion is inthe axis about which the head is rotated to perform the maneuver for theremoval of the otoconial crystals from the posterior SCC for the reliefof posterior SCC BPPV. The center of the sighting mark 306 in the supineposition, head extended 20 degrees, lies approximately in the planeformed by position bull's eyes No. 1, No. 2, No. 3. The line of theentrapment protrusion 340 is approximately perpendicular to this plane.

Referring to FIG. 104, a line from the center of the inner sphere to thecenter of the entrapment slot and a line from the center of the innersphere to any of the position bull's eyes or points along the path areat approximately a 90 degree angle. When the user lies supine and headextended 20 degrees, the center of the sighting mark is at a 90 degreeangle to the axis of the entrapment protrusion.

When the user rises from supine with 20 degree neck extension to aclassic supine position, FIG. 107, the center of the sighting mark movesto the bottom of the inner sphere and the center of the entrapment slotmoves to a horizontal position. Because the entrapment slot isapproximately 45 degrees in width, in FIG. 104, the entrapmentprotrusion will have moved to approximately the top end of theentrapment slot, but the inner sphere will not have moved.

When the user rises from a classic supine position to a sitting uprightposition, FIG. 108, the inner sphere is rotated in the plane formed bythe center of the inner sphere, the entrapment protrusion and the centerof the weight in the inner sphere. During this position change, theinner sphere is rotated approximately 87.5 degrees.

The placement of the position bull's eyes for the treatment of post SCCBPPV, FIGS. 11-17, and the method of treatment for post SCC BPPV whenthe inner sphere horizontal axis is controlled by the entrapmentembodiment is like the method used in the embodiment of FIG. 30-41. Theplacement of the position bull's eye (R and L) for BPPV diagnostictechnique and the method for post BPPV when inner sphere horizontal axisis controlled by the entrapment embodiment is like the method used inembodiment FIGS. 27-29. The entrapment embodiment cannot be used totreat horizontal BPPV Rx.

Detailed description of the left posterior semicircular canal BPPVtreatment showing body positions and goggle apparatus using entrapmentembodiment.

Principles in Action. Reference is Made to FIGS. 109-142

When the sighting mark has within it a position bull's eye or positionbull's eye path, FIGS. 117, 122, 127, 132, then the entrapmentprotrusion 340 is free to move within the entrapment slot 350 and willtend to seek its free floating axis orientation of 20 degrees from thehorizontal, FIGS. 117, 122, 127, 132. When the sighting mark has withinit a position bull's eye or position bull's eye path 117, 122, 127, 132then the long axis S of the head. FIGS. 115, 120, 125, 130 is in a 20degree top-of-head-down relationship with the horizontal plane.

The plane defined by the position bull's eyes is approximatelyperpendicular to the axis of the entrapment protrusion FIGS. 112, 117,122, 127, 132, 137, 139. When the target sighting mark has within iteither a positioning bull's eye or the position bull's eye path then thelong axis S of the user's head is parallel to the entrapment protrusiondefined axis i.e. 20 degrees from the horizontal. If the relationshipbetween the users head and the goggle device is constant, then when theposition bull's eye or position bull's eye path is kept within thetarget sighting mark and the head is rotated 180 degrees from positionbull's eye to No. 1 to position bull's eye No. 3, the maneuver will becorrectly completed.

One of the difficult aspects of the maneuver is to keep the head in the20 degree top-of-head-down plane during the transition from headposition No. 2, FIGS. 119, 120 to head position No. 3, FIGS. 124, 125.In this transition, the user goes from the lying on his back in a neckextended position, FIGS. 119, 120, to lying on his right side in a neckflexed (or chin tucked) position FIGS. 124, 125. During this transitionthere is a period during which the neck must be bent laterally anddownward to keep the long axis of the head top-of-head-downward by 20degrees. This occurs as the user is rolling onto his shoulder oppositethe ear being treated. The visual feedback is necessary to keep the longaxis of the head position correct.

It is also necessary to have visual feedback to the user while theuser's head is kept in head position No. 3, FIGS. 124, 125, 129, 130,but the user is transitioning from the face downward position whilelying on his right side, FIGS. 124, 125, to the crawl position, FIG.129, 130. Maintaining the head in the same position is difficult withoutvisual feedback.

FIGS. 109-113 show the user in the start position sitting up with apillow placed to support and elevate his back, FIGS. 109, 110. The usercan see no markings within the target sighting mark FIG. 113. The user'seye, the target sighting mark and the center of the inner sphere arelocated along the horizontal axis. A line from the center of the targetsighting mark. to the center of the inner sphere and a line from thecenter of the entrapment slot to the inner sphere form a 90 degreeangle. A line from the center of the inner sphere weight 320 to thecenter of the inner sphere and a line from the entrapment protrusion tothe center of the inner sphere form an angle of 110 degrees. Theentrapment slot forms a 45 degrees arc. Therefore from the center of theentrapment slot to the end furthest from the target sighting mark is a22.5 degrees arc. A horizontal line passing through the center of theuser's pupil, through the center of the target sighting mark and throughthe center of the inner sphere and a line passing through the center ofthe weight 320 and the center of the inner sphere form an angle of 2.5degrees. The center of the weight is below the horizontal line.

FIGS. 114-118 show the user lying on his back with his head turned tothe left 45 degrees and his neck extended 20 degrees. During the lyingdown process, the user moves his head and the attached target sightingmark backward. When the head has been rotated backward toward horizontal87.5 degrees, the weight 320 has reached its lowest point and the innersphere ceases to be moved in the vertical plane by the inner sphereentrapment protrusion and the outer sphere entrapment slot interaction.The user lies down and extends his neck 20 degrees and the targetsighting mark moves another 22.5 degrees and comes to have within iteither the position bull's eye or the position bull's eye path. At thistime the entrapment protrusion is in the center of the entrapment slot.So long as the target sighting mark stays on a position bull's eye orposition bull's eye path, the entrapment protrusion will move verticalfreely within the entrapment slot, except during a brief period in thetransition from head position No. 2 to head position No. 3. Since theplane defined by the three position bull's eye is perpendicular to theentrapment protrusion axis DP, the user can now rotate his head in theplane defined by the position bull's eyes. By rotating his head 180degrees in the plane defined by the position bull's eye from headposition No. 1 to head position No. 3, the post SCC BPPV treatmentmaneuver can be successfully accomplished.

In FIG. 117, the entrapment protrusion can be seen to be moving freelywithin the entrapment slot and the target sighting mark has within itthe position bull's eye No. 1, FIGS. 117, 118. Whenever the targetsighting mark is in the plane defined by the position bull's eyes, theentrapment protrusion will be moving freely vertically within theentrapment slot and the user's head will be at a 20 degreestop-of-head-down angle to the horizontal plane. The key to successfullyperforming a maneuver is to maintain his head long axis S orientationduring the rotation of the head in the plane defined by the positionbull's eyes.

FIGS. 119-123 show the user lying on his back with his head turned tothe right 45 degrees, FIGS. 119, 120 with his neck extended 20 degrees.The user has kept the position bull's eye path within the targetsighting mark and has turned his head 90 degrees to the right, FIGS.119, 120, such that he has the position bull's eye No. 2 in the targetsighting mark, FIG. 123.

FIGS. 124-128 show that the user has rolled 90 degrees from position No.2, FIG. 121, to position No. 3, FIG. 126, onto his right side and hasturned his face downward at a 45 degree angle to horizontal, FIGS. 124,125. He has also gone from a neck extended, FIGS. 114, 115, 119, 120, toa neck flexed (chin tucked toward chest) position, FIGS. 124, 125, Thisrequires that the user not only transition from neck extension to neckflexion but do so while rolling onto his right shoulder. In the middleof this transition the user must bend his neck laterally to maintain thetop-of-head downward angle relative to the horizontal plane. This isaccomplished by keeping the bull's eye path within the target sightingmark during the movement.

FIGS. 124, 125, 129, 130, show that the user has maintained the samehead position, FIGS. 126, 127,128, 131, 132, 133, and has moved from aright side down position, FIGS. 124, 125, to the crawl position, FIGS.129, 130.

FIGS. 129, 130, 134-140 show the user having moved from the crawl, FIGS.129, 130, to the kneeling position, FIGS. 134, 135. As the user movesfrom the crawl to the kneeling position, several changes occur in thedevice. When the user raises his head 22.5 degrees from the neck-flexedposition, FIG. 132, the entrapment protrusion comes to rest on theentrapment slot end most distant from the target sighting mark, FIG.107. As the user raises his head to the upright (vertical) position,FIGS. 137, 139, the line from the center of gravity of the weight israised to slightly above the horizontal position. The user is nowlooking at the opposite side of the inner sphere, FIG. 137, than theside which he saw in the start sitting position FIG. 139. If the userraises his head or certainly when the user begins to lie on his back torepeat the maneuver, the weight will move downward and rotate the innersphere around the axis of the entrapment protrusion and move the innersphere outer surface which is closest to the weight into the user's lineof sight, FIG. 139.

FIG. 141 shows the 180 degree rotation of the user's head around theentrapment protrusion axis seen end on for treatment of left posteriorSCC BPPV.

FIG. 142 shows a view of the complete sequence of head positions forleft posterior SCC BPPV treatment from the point of view in line withthe entrapment protrusion axis 20 degrees from the horizontal. In FIG.1421, the back of the user's head in the sitting position is seen. InFIG. 14211, the user lies down with 20-degree neck extension allowingthe entrapment protrusion axis to be seen end on and turns his head 45degrees to the left (Head position No. 1). He then maintains the neckextension and turns his head 90 degrees to the right to head positionNo. 2, FIG. 142 III. He turns his head to the right another 90 degreewhile maintaining the top-of-head-down 20 degrees extending his necklaterally 20 degrees, rolls onto his right shoulder and flexes his neck20 degrees into head position No. 3, FIG. 142 IV. Maintaining the headposition No. 3, FIG. 142 IV, the user moves into a crawl position FIG.142 V. The user moves from a crawl position to the kneeling positionFIG. 142 VI.

Inner Sphere Marking Variations

Referring to FIGS. 143-149, there will be described inner sphere markingvariations. As previously described under PBPPV observations, the bestsequence of head positions for clearing crystals from the posteriorcanal is the position sequence that would cause position No. 2 to havethe top of the patient's head pointed directly downward. Moving theposition bull's eye No. 2 to a position that requires greater neckextension in position No. 2 of posterior SCC BPPV treatment willincrease the effectiveness of the maneuver. FIG. 143 illustrates aninner sphere 305 with a vertical equator 305VE. FIG. 144 is a view ofFIG. 143 as seen along lines 144—144 thereof and illustrating theangular relationship of the three position bull's eyes. The positionbull's eye No. 1 is 45 degrees from the vertical equator 305VE. Theposition bull's eye No. 2 is 45 degrees from the vertical equator on theopposite side from the bull's eye position No. 1. The position bull eyeNo. 3 is 135 degrees from the vertical equator on the same side of thevertical equator 305VE as position bull's eye No. 2. FIG. 145 shows theorientation of position bull's eyes No. 1, No. 2, and No. 3 relative tothe vertical equator shown in FIG. 143. As previously noted, positionNo. 1 bull's eye is 20 degrees from the equator measured by the equatorand a line from the center of the ball to position No. 1. Position No. 2bull's eye is 30 degrees from the equator as measured from the equatorand the line drawn from the center of the inner sphere to position No.2. Position No. 3 is 20 degrees from the vertical equator measured by aline from the center of the inner sphere to the position bulls eye No.3. Position bulls eye No. 3 is on the opposite side of the verticalequator from positions No. 1 and No. 2. FIGS. 146 and 147 show thislocation modification of position bull's eye No. 2. The increase in theextension of the neck during the transition from Position No. 1 toPosition No. 2 increases the effectiveness of the posterior SCC BPPVcrystal moving maneuver. Clinically it is difficult to find patientswhose necks are limber enough to perform this greater than 20 degreeextension in position No. 2, but for those who are able to extendfurther in position No. 2 than 20 degrees, it makes the maneuver moreeffective. FIGS. 146 and 147 show the same change in position bull's eyeNo. 2 for right posterior BPPV treatment first component. FIGS. 148 and149 show the same change in position bull's eye No. 2 for left posteriorBPPV treatment first component. The angular position No. 2 of the innersphere 305 of the embodiment of FIGS. 18-24 may be modified in a similarmanner.

Other Embodiments First Component

Hanging Object Device

Referring now to FIGS. 150-165, there will be described a hanging objectdevice which attaches to the user's head to measure head position and togive the user visual feedback about his head position or series of headpositions.

Referring first to FIGS. 150 and 151, the first component 600 comprisesa clear, transparent, plastic, hollow, outer sphere 602. From the topinside of the sphere 602, within the outer sphere is a indicatorsuspension rod 604 which extends from the dead top center 602C of thesphere 602 to the sphere mid-point 605. A flexible indicator suspensionstring 609 has one end attached to the mid point 606. An indicator 611is attached to the other end of the string 609. The indicator suspensionstring 609 and indicator 611 are free to move, with the indicator beingan object that will be controlled by gravity.

The hanging object device first component 600 is located within thesecond component 405. In FIG. 151, the sphere 602 is shown partially inthe tube 405. The clear plastic tube second component 405 holds thehanging object sphere center 605 at the focal distance of the 20 diopterlens 410. The diameter outside of the hanging object device 600 isapproximately equal to the inside diameter of the second component clearplastic tube 405. It is to be understood that the length of the tube 405will be sufficient such that the full diameter of the sphere 602 will belocated in the tube 405 with the center 605 at the focal length of thelens 410. In this configuration the user must be able to visualize theentire circumference of the hanging object device 600 in order to followthe indicator 611 movement within the sphere 602.

There are three spheres 602 used in this embodiment. One sphere 602D isused for diagnostic purposes and two spheres 602TR and 602TL are usedfor treatment purposes. All three spheres are hollow and have atransparent outer wall and have the indicator suspension rod 604, string609 and indicator 611 of FIG. 150 and all three spheres will fit in aholding tube 405 as shown in FIG. 151. The diagnostic position markconfiguration is shown in FIGS. 153-157. The treatment markconfiguration for the treatment of right posterior SCC BPPV is shown inFIGS. 162, and 163 and for left posterior SCC BPPV is shown in FIGS. 164and 165.

As in the preferred embodiment described previously, the orientation ofthe position marks and the numbering of the position marks can bearranged such that the hanging object device can be used to guide theuser through head position sequences which will 1) position the head inclassic Dix Hallpike diagnostic positions for right and left posteriorSCC BPPV, 2) guide the user through the head position sequences whichwill allow the loosened crystals to fall out of the right or leftposterior SCC resolving the symptoms of posterior SCC BPPV, or 3) guidethe users through the head positions sequences which will allow theloosened crystals to fall out of the right or left horizontal SCCresolving the symptoms of horizontal SCC BPPV.

Hanging Object Device Position Mark Configuration

Diagnostic Position Mark Configuration

The locations of the position marks used in the hanging object devicethat will guide the user into the classic Dix Hallpike positions to helpin the diagnosis of posterior SCC BPPV and to help differentiate rightposterior SCC BPPV from left posterior clear SCC BPPV are shown in FIGS.152-157. FIG. 152 shows the clear sphere 602D with a vertical equator602VE. FIG. 153 is a view of FIG. 152 seen along lines 153—153 thereof.FIG. 153 indicates that from a top view, with the arrow 615 at thebottom of FIG. 153 showing the user's view of the R and L markers, eachof these is 45 degrees to the right and left, respectively, of the lineof sight of the user. FIGS. 154 uses the orientation of FIG. 152. FIG.155 is a view of FIG. 154 as seen along lines 155—155 thereof. FIG. 155indicates that the R and L position markings are 20 degrees above thehorizontal equator 602HE. FIG. 156 shows the position marks of R and Lfrom the users view on the outer sphere of the hanging object device.The lines 617 and 619 show the path the user is instructed to cause theindicator 611 to follow in his head motion to cause his head to comeinto the right and left Dix Hallpike diagnostic position. FIG. 157 is aview of FIG. 156 as seen along lines 157—157 thereof. FIG. 157 is theview of the R and L position marks shown in FIG. 156.

Hanging Object Device Position Mark Configuration

Posterior SCC BPPV Treatment Position Mark Configuration

The locations of the position marks used to guide the user's headthrough the sequence of positions which will cause the loosened crystalsto fall out of the right and left posterior semicircular canals andhence resolve the symptoms of BPPV are shown in FIGS. 158-165. In FIGS.158-161 the treatment sphere is identified at 602T. FIG. 158 shows theclear sphere 602T with a vertical equator. FIG. 159 is a view of FIG.158 as seen along lines 159—159. FIG. 159 shows, from a top perspective,the orientation of position marks No. 1, No. 2, and No. 3. The arrow atthe bottom of FIG. 159 shows the user's line of sight 621. FIG. 159shows the orientation from the top of the right posterior semicircularcanal treatment position marks. Position mark No. 1 is 45 degrees to theright of the viewer's perspective, where the angle is formed by theuser's line of sight and a line from the center of the sphere to theposition mark No. 1; position mark No. 2 is 45 degrees to the left ofthe user's line of sight, where the angle is formed by the user's lineof sight and a line from the center of the sphere to the position markNo. 2 which is 45 degrees to the left. Position mark No. 1 and positionmark No. 2 are 90 degrees from each other. Position mark No. 3 is 135degrees to the left of the user's line of sight on the back side of theclear sphere. Treatment of the left posterior semicircular canal BPPVorientation is reversed such that position mark No. 1 is 45 degrees tothe left of the user's line of sight and position mark No. 2 is 45degrees to the right of the user's line of sight and position mark No. 3is 135 degrees to the right of the user's line of sight. FIG. 160 againshows the same vertical equator diagram as FIG. 158 with FIG. 161 beinga view of FIG. 160 as seen along lines 161—161 thereof. FIG. 161indicates that position marks No. 1 and No. 2 in both right and leftposterior semicircular canal BPPV treatment configurations are 20degrees above the horizontal equator 602HE where the angle is formed bythe user's line of sight and a line from the center of the sphere to theposition marks No. 1 and No. 2; and position mark No. 3 is 20 degreesbelow the horizontal equator, whereby the angle is formed by the user'sline of sight and line from the center of the sphere to the positionmark No. 3.

FIG. 162 indicates the specific layout of the specific position marklocation configuration on sphere 602TR for the treatment of rightposterior semicircular canal BPPV. The perspective of FIG. 162 is theperspective of the user's line of sight 621 in FIG. 159. It showsposition mark No. 1, 20 degrees above the horizontal equator 602HE and45 degrees to the right of the user's line of sight. Position mark No. 2is 20 degrees above the horizontal equator 602HE and 45 degrees to theleft of the user's line of sight. Position mark No. 3 is 135 degrees tothe left of the user's line of sight and 20 degree below the horizontalequator. Lines 607, indicate the path between mark Nos. 1, 2, and 3.FIG. 163 is a view of FIG. 162 as seen along lines 163—163 thereof. FIG.163 shows position marks No. 1 and No. 2, 20 degrees above the equator603HE, 90 degrees from each other. Position mark No. 2 is 45 degrees tothe right of the user's line of sight. It shows position mark No. 3, 45degrees to the left (See FIG. 163) of the user's line of sight and 20degrees below the horizontal equator. The angle between position markNos. 2 and 3 is 90 degrees. FIG. 164 shows the position mark locationconfiguration for the sphere 602TL of the hanging object device leftposterior BPPV treatment position mark configuration. FIG. 164 is theview of the user's line of sight. In FIG. 164, position mark No. 1 is 20degrees above the horizontal equator and 45 degrees to the left of theviewer's line of sight. Position mark No. 2 is 45 degrees to the rightof the user's line of sight and 20 degrees above the horizontal equator.Position mark No. 3 is 20 degrees below the horizontal equator and 135degrees to the right of the user's line of sight. Lines 607 indicate thepath between mark Nos. 1, 2, and 3. FIG. 165 is a view of FIG. 164 asseen along lines 165—165 thereof FIG. 165 shows the position mark No. 1,20 degrees above and 45 degrees to the right of the user's line ofsight. Position mark No. 2 is 135 degrees to the right and 20 degreesabove the horizontal equator. Position mark 3 is 135 degrees to the leftof the user's line of sight and 20 degrees below the horizontal equator.

Hanging Object Device Method Description

Diagnostic Method Description

To diagnose the right and left posterior semicircular canal BPPV usingthe hanging object device.

The user is instructed to sit on the floor and/or mat and put thegoggles over his eyes (with the combination 400, 602D in place) in sucha manner that the clear sphere 602D, the position marks “R” and “L”, andthe indicator 611 are clearly seen, FIG. 27.

The user is instructed to lie supine in position “R”, FIG. 28.

The pillow is rolled lengthwise and used longitudinally under the spinefrom C5 to L1. The user is instructed to place the pillow on the matbehind him such that the pillow will be positioned under his upperthoracic spine (not under this shoulder). He then is instructed to liebackward upon the pillow and the floor. The user is instructed to findthe positioning mark “R”, FIG. 156. The user is now instructed to findthe indicator 611 and move his head such that he positions the indicator611 proximate to position mark “R”. He is to stay in this position for30 seconds or until his dizziness resolves.

Sit on the floor and/or mat with goggles over his eyes, FIG. 27. Theuser is instructed to return to the upright sitting position and waitfor his dizziness to resolve.

Lie supine in position “L”, FIG. 29.

The pillow is rolled lengthwise and laid longitudinally under the spinefrom C5 to L1. He is instructed to place the pillow on the mat behindhim such that the pillow will be placed under his upper thoracic spine(not his shoulder). He is instructed to lie backward upon the pillow andfloor. The user is now instructed to find the indicator 611 and move hishead such that the indicator 611 is positioned proximate to the position“L”. He is to stay in this position for 30 seconds or until hisdizziness resolves.

Return to sitting position, FIG. 27.

The user is instructed to sit upright. He is instructed to remove thegoggles, wait 30 seconds or until his dizziness resolves.

The user is instructed to determine whether placing his head in theposition such that the indicator 611 is approximate to the position mark“R” causes more dizziness than placing his head in the position suchthat the indictor 611 is proximate to “L” position mark. If the user hasgreater dizziness when the indicator 611 is proximate to “L”, then theleft posterior SSC is effected by BPPV. If the user has more dizzinesswhen the indictor 611 is proximate to the “R” then the right posteriorSCC is effected by BPPV.

Method For Posterior SCC BPPV Treatment

Treat Right Posterior SCC BPPV:

Sit on the floor and/or mat with goggles over eyes (FIG. 30) and theright posterior SCC hanging device treatment sphere 602TR in place.

The user is instructed to sit on the floor or on a mat and put thegoggles over this eyes in such a manner that the clear outer sphere602TR and the indicator 611 are clearly seen. The right posterior SCCBPPV treatment first component is 602TR in place.

Lie supine in position No. 1 (FIG. 31).

The pillow is rolled lengthwise and placed longitudinally under thespine from C5 to L1. The user is instructed to place a pillow on the matbehind him such that the pillow will be positioned under his upperthoracic spine (not under his shoulders). He is then instructed to liebackward upon the pillow and floor. The user now is instructed tovisually find the indicator 611 (FIG. 150) and position it at positionmarking No. 1, FIGS. 162, 163. He is to stay in this position for thirtyseconds or until his dizziness resolves.

Lie supine in position No. 2 (FIG. 32).

The user then moves his head such that the indicator 611 moves along theprinted path 607 on the outer sphere until the indicator 611 moves toposition marking No. 2. He is instructed to stay in this position forthirty second or until the dizziness resolves.

Lie on left side with head turned downward 135 degrees (FIG. 33).

The user now is instructed to roll upon his left side and simultaneouslymove his head such that the indicator 611 follows the printed path 607to the position marking No. 3. He is instructed to remain in thisposition for thirty seconds or until the dizziness resolves.

Roll into crawl position (FIG. 34).

The user is instructed to move his head such that the indicator 611stays aligned with the position mark No. 3, (FIGS. 162, 163) and rolltoward his left side into a crawl position. He is to remain in thisposition for thirty seconds or until any dizziness resolves.

Come up to a kneeling position (FIG. 35).

The user is instructed to raise his torso into a kneeling position andsteady himself for thirty second or until the dizziness resolves.

Either repeat or move goggles.

If the user was dizzy upon going from the crawl to the kneelingpositions, the user is now instructed to repeat the maneuver. If therewas no dizziness when the user goes form the crawling to the kneelingpositions, the user is instructed to stop the maneuvers and remove thegoggles.

Treat Left Posterior SCC BPPV:

Sit on the floor and/or mat with goggles over eyes (FIG. 36) and theleft posterior SCC hanging device treatment sphere 602TL (FIGS. 164,165) in place.

The user is instructed to sit on the floor or on a mat and put thegoggles over this eyes in such a manner that the clear outer sphere602TL and the indicator 611 are clearly seen . The left posterior SCCBPPV treatment first component 602TL is in place.

Lie supine in position No. 1 (FIG. 37).

The pillow is rolled lengthwise and placed longitudinally under thespine from C5 to L1. The user is instructed to place a pillow on the matbehind him such that the pillow will be positioned under his upperthoracic spine (not under this shoulders). He is then instructed to liebackward upon the pillow and floor. The user now is instructed tovisually find the indicator 611 (FIG. 150) and position it at positionmarking No. 1, FIGS. 164, 165. He is to stay in this position for thirtyseconds or until his dizziness resolves.

Lie supine in position No. 2 (FIG. 38).

The user moves his head such that the indicator 611 moves along theprinted path 607 on the outer sphere until the indicator moves toposition marking No. 2. He is instructed to stay in this position forthirty seconds or until the dizziness resolves.

Lie on right side with head turned downward 135 degrees (FIG. 39).

The user now is instructed to roll upon his right side andsimultaneously move his head such that the indicator 611 follows theprinted path 607 to the position marking No. 3 (FIGS. 164, 165). He isinstructed to remain in this position for thirty seconds or until thedizziness resolves.

Roll into crawl position (FIG. 40).

The user is instructed to move his head such that the indicator 611stays aligned with the position mark No. 3 (FIGS. 164, 165) and rolltoward his right side into a crawl position. He is instructed to remainin this position for thirty seconds or until any dizziness resolves.

Come up to a kneeling position (FIG. 41).

The user is instructed to raise his torso onto a kneeling position andsteady himself for third seconds or until the dizziness resolves.

Either repeat or remove goggle. If the user was dizzy upon going fromthe crawl to the kneeling positions, the user is now instructed torepeat the maneuver. If there was no dizziness when the user goes formthe crawling to the kneeling position, the user is instructed to stopthe maneuvers and remove the goggles.

Other Embodiments First Component

Sand Particles in Tube Device

Referring to FIGS. 166-170, the device attaches to the user's head toreflect head position and to give the user visual feedback about hishead position or series of head positions.

The device comprises a hollow torodial shaped tube 651 having atransparent wall 651T which contains a liquid 652 in which are locatedsand particles 653 or other types of particles or crystals. The sandparticles can be used to give the user visual feedback about his headposition for the diagnosis of post BPPV and the differentiation of rightfrom left post BPPV, or his head position to allow the resolution ofsymptoms of right or left posterior SCC BPPV. The liquid may be water.The device 651 is mounted within the second component 400 as shown inFIGS. 167 and 168. FIG. 162 is a side view. FIG. 168 is a top view. Inthese Figures the clear plastic tube 405 and the 20 diopter lens 410could be the same as in the preferred embodiment. The outer diameter ofthe toroid 651 is approximately equal to the inside diameter of theclear plastic tube 405.

For treatment of the right posterior SCC BPPV the second component 400is configured in the following manner. From a top view FIG. 168, for usein the right posterior BPPV treatment the toroid 651R is located in thecylindrical tube 405 at an angle of 45 degrees relative to the axis ofthe member 405 with the distal edge of the toroid located close to theleft side of the tube 405 as shown in FIG. 168. Thus the sand in thetube device 651 is aligned at 45 degrees from the line of the sight ofthe user. The position of the toroid 651 furthest from the user ispositioned closest to the left side of the second component.

For treatment of left posterior SCC BPPV, the second component 400 isconfigured in the following manner. From a top view, FIG. 169, for usein the left posterior BPPV treatment, the toroid 651L is located in thecylindrical member 405 at an angle of 45 degrees relative to the axis ofthe member 405 with the distal edge of the toroid located to the rightside of the member 405 as shown in FIG. 169. Thus the sand in the tubedevice 651 is aligned at 45 degrees from the line of the sight of theuser. The portion of the tube circle furthest form the user ispositioned closest to the right side of the second component.

For purposes of instruction, the sand in the tube device is divided intofour 90 degrees areas. These areas are shown in FIG. 170. Area A is thebottom quadrant, Area B is the quadrant closest to the users eye. Area Cis the top quadrant of the tube and Area D is the quadrant furthest fromthe user's eye.

Method for Posterior SCC BPPV Treatment

Treat Right Posterior SCC BPPV:

Sit on the floor and/or mat with goggles over eyes (FIG. 30).

The components 405, 651R will be coupled to the goggles 500.

The user is instructed to sit on the floor or on a mat and place thetube 651R configured for right posterior SCC BPPV treatment over hiseyes in such a manner that the sand in the tube 651R is clearly seen.

Lie supine in position No. 1 (FIG. 31).

The pillow is rolled lengthwise and placed longitudinally under thespine from C5 to L1. The user is instructed to place a pillow on the matbehind him such that the pillow will be positioned under his upperthoracic spine (not under this shoulders). He then is instructed to liebackward upon the pillow and floor. The user is now instructed to extendhis neck to allow the crystals to fall from the A area FIG. 170 of thetube 651R in the sand device into the B area of the 651R tube. He is tostay in this position for thirty seconds or until his dizzinessresolves.

Lie supine in position No. 2 (FIG. 32).

The user then moves his head, keeping his neck extended, such that thecrystals fall from B area to the top or C FIG. 170 area of the tube651R. He is instructed to stay in this position for thirty seconds oruntil the dizziness resolves.

Lie on left side with head turned downward 135 degrees (FIG. 33).

The user now is instructed to keep his neck extended and to roll uponhis left side and cause the crystals to fall from the C FIG. 170 area ofthe tube 651R into the D area of the tube 651R. He is instructed toremain in this position for thirty seconds or until the dizzinessresolves.

Roll into crawl position (FIG. 34).

The user is instructed to keep his head in the position describedimmediately above then roll toward the left side into a crawl position.He is instructed to remain in this position for thirty seconds or untilany dizziness resolves.

Come up to a kneeling position (FIG. 35).

The user is instructed to raise his torso into a kneeling position andsteady himself for thirty seconds or until the dizziness resolves.

Either repeat or remove goggle. If the user was dizzy during themaneuver sequence, the user is now instructed to repeat the maneuver. Ifthere was no dizziness during the maneuver sequence, the user isinstructed to stop the maneuvers and remove the goggles.

Treat Left Posterior SCC BPPV:

Sit on the floor and/or mat with goggles over eyes (FIG. 36).

The components 405, 651L will be coupled to the goggles 500.

The user is instructed to sit on the floor on a mat and place the 651Lconfigured for left posterior SCC BPPV treatment FIG. 169 over his eyesin such a manner that the sand in the tube 600L first component isclearly seen.

Lie supine in position No. 1 (FIG. 37).

The pillow is rolled lengthwise and place longitudinally under the spineform C5 to L1. The user is instructed to place a pillow on the matbehind him such that the pillow will be positioned under his upperthoracic spine (not under his shoulders). He then is instructed to liebackward upon the pillow and floor. The user is now instructed to extendhis neck to allow the crystals to fall from the A area FIG. 170 of the651L tube in the sand device into the B area FIG. 170 of the tube. He isto stay in this position for thirty seconds or util his dizzinessresolves.

Lie supine in position No. 2 (FIG. 38).

The user then moves his head, keeping his neck extended, such that thecrystals fall from B area FIG. 170 to the top or C area of the tube651L. He is instructed to stay in this position for thirty seconds oruntil the dizziness resolves.

Lie on right side with head turned downward 135 degrees (FIG. 39).

The user now is instructed to keep his neck extended and in contact withthe floor and to roll upon his right side and cause the crystals to fallfrom the C area FIG. 170 of the tube 651L into the D area of the tube.He is instructed to remain in this position for thirty seconds or untilthe dizziness resolves.

Roll into crawl position (FIG. 40).

The user is instructed to keep his head in the position describedimmediately above and roll toward the right side into a crawl position.He is instructed to remain in this position for thirty seconds or untilany dizziness resolves.

Come up to a kneeling position (FIG. 41).

The user is instructed to raise his torso into a kneeling position andsteady himself for thirty seconds or until the dizziness resolves.

Either repeat or remove goggle. If the use was dizzy upon going from thecrawl to the kneeling positions, the user is now instructed to repeatthe maneuver. If there was no dizziness when the user goes from thecrawl to the kneeling position, the user is instructed to stop themaneuvers and remove the goggles.

Other Embodiment First Component

Rolling Ball Embodiment

Referring to FIGS. 171-188, there will be described a rolling balldevice which attaches to the user's head to measure head position and togive the user visual feedback about his head position or series of headpositions. Diagrams 171-188 show the ridge path as solid lines on theforeground side of the sphere and ridge pair paths on the backgroundside of the sphere as dotted, recognizing that all ridge pair paths areon the inner surface of the outer sphere.

In this embodiment the outer treatment sphere comprises a clear,transparent, plastic hollow sphere 700 as shown in FIG. 172. Within thisclear outer sphere is a smaller inner sphere or ball 710. The insidediameter of the outer sphere is approximately 1½ inches. The outsidediameter of the inner sphere 710 is approximately ¼ inch. It is to beunderstood that these dimensions may vary. The inner sphere is free toroll around within the outer sphere. On the outside surface of the outerclear sphere are printed position bull's eye which are marked “1”, “2”,and “3”. On the inner surface of this clear plastic sphere are pairs ofridges 720A and 720B which outline or define a path 720P of travel forthe small inner sphere 710.

The ridges 720A and 720B are approximately 5 mm apart and approximately1 mm in height. It is to be understood that these dimensions may vary.In order to complete the maneuver, the user is to position his head suchthat he can maneuver the small inner sphere into an entrance 721 betweenthe ridge pair near position bull's eye No. 1 and then move the ballalong the ridge pair from position bull's eye No. 1 to No. 2, and to No.3, pausing at each position bull's eye for his dizziness to resolve andthen out of the ridge pair opening 723 on the opposite side of positionbull's eye No. 3 from position bull's eye No. 2.

This ridge pair has the functional characteristic that as the innersphere is moved along the ridge pair, if the user gets too far out ofthe head position maneuver sequence, the inner sphere will escape fromthe ridge pair track and the user will have to restart the maneuver bymoving his head such that the inner sphere returns to position No. 1,where the inner sphere can reenter the ridge pair path and the maneuvercan be repeated until it is performed properly. Additionally the heightof the ridges can vary from one area of the ridge pair path to another.That is, in the portions of the maneuver in which positioning is lesscritical, the ridge pair path height can be higher, but in areas wherehead position is critical the ridge height can be lower. This allows thedevice to have head position maneuver tolerances built into the device.

The sphere 700 sits within the second component 405 shown in FIG. 174.The clear plastic tube second component 405 holds the rolling ball outersphere center 700C, FIG. 172, at the focal distance of the 20 diopterlens 410. The diameter of the rolling ball outer sphere 700 isapproximately equal to the inside diameter of the second component clearplastic tube 405. In this configuration the user must be able tovisualize the entire circumference of the rolling ball device 700 inorder to follow the inner sphere's 710 movement within the outer sphere.

The origination of the position marks and numbering of the positionmarks on the outer sphere 700 of the rolling ball embodiment arearranged such that the rolling ball embodiment is used to guide the userthrough head position sequences which will 1) position the head inclassic Dix-Hall Pike positions for diagnosis of right or left posteriorsemicircular canal; 2) guide the head into classic Dix-Hall Pikepositions for diagnostic differentiation of right posterior semicircularcanal BPPV vs. left posterior semicircular canal BPPV, or 3) guide theuser's head through head position sequences which will allow theloosened crystals to fall out of the right or left posteriorsemicircular canal, resolving the symptoms of posterior semicircularcanal BPPV.

Rolling ball embodiment position mark configuration.

Diagnostic position mark configuration,

The locations of the position marks used in the rolling ball device thatwill guide the user into the classic Dix-Hall Pike positions to help inthe diagnosis of posterior semicircular canal BPPV and to helpdifferentiate right from left posterior semicircular canal BPPV areshown in FIGS. 175-180. FIGS. 175-180 illustrate a hollow outerdiagnostic sphere 700D with inside ridges 720AD and 720BD forming a path720PD for an inner ball or sphere 700D. FIG. 175 shows the clear outersphere 700D with a vertical equator 700DVE. FIG. 176 is a view of FIG.175 as seen along lines 176-176 thereof. In FIG. 176, the arrow at thebottom of the figure is the user's view of the “R” and “L” markings.From the perspective of FIG. 176, the “R” marking is 45 degrees to theright of the user's line of sight and the “L” marking is 45 degrees tothe left of the user's line of sight. FIG. 177 has the orientation ofFIG. 175.

FIG. 178 indicates that the “R” and “L” position markings are 20 degreesabove the horizontal equator 700DHE.

FIG. 178 is a view of FIG. 177 as seen along lines 178—178 thereof. The20 degree angle is formed between a line between the center of thehorizontal equator and a line that extends from the center of the ballto the positions “R” and “L”. FIG. 179 shows the position marks “R” and“L” from the user's point of view from the outer surface of the sphere700. The dotted lines show the raised ridge pair path 720P of the clearplastic outer sphere 700. The inner sphere must enter the ridge pair720P at the bottom or near the bottom of the clear outer sphere at 720DEand roll along the path to the “R” position mark or “L” position mark.FIG. 180 is a view of FIG. 179 as seen along lines 180—180 thereof. InFIG. 180, the right mark is behind and in line with the left mark and isnot shown. It again shows that the “R” and “L” markings are 20 degreesabove the horizontal equator as demonstrated in FIG. 178.

Rolling ball device position mark configuration.

Posterior semicircular canal BPPV treatment position mark configuration.

The locations of the position marks used to guide the user's headthrough the sequence of positions which will cause the loosened crystalsto fall out of the right and left posterior semicircular canals andresolve the symptoms of BPPV are shown in FIGS. 181-188. FIG. 181 showsthe clear plastic outer sphere 700 with the vertical equator 700VE. FIG.182 shows the horizontal plane orientation of position marks No. 1, No.2, and No. 3. FIG. 182 is a view of FIG. 181 as seen along lines182—182. The arrow at the bottom of FIG. 182 indicates the user's lineof sight. In right posterior semicircular canal BPPV configuration,shown as an example in FIG. 182, position Nos. 1 mark is 45 degrees tothe right of the line formed by the user's line of sight and a linegoing from the center of the sphere to the position mark No. 1. Positionmark No. 2 is 45 degrees to the left of the user's line of sight. The 45degree angle is formed between the line of sight of the user and a linegoing from the center of the sphere to the position No. 2. Position No.3 is 135 degrees to the left of the user's line of sight. FIG. 183 showsthe clear plastic outer sphere 700 with the vertical equator 700VE. FIG.184 is a view of FIG. 183 as seen along lines 184-181 thereof. FIG. 184shows that position marks No. 1 and No. 2 in both right and leftposterior semicircular canal BPPV treatment configuration are 20 degreesabove the horizontal equal when the 20 degrees is measured between thehorizontal equator 700HE and the line going from the center of thesphere to the position marks No. 1 and No. 2. Position mark No. 3 is 20degrees below the horizontal equator as measured by an angle between thehorizontal equator and a line going from the center of the sphere to theposition mark No. 3.

FIG. 185 shows the position marking configuration for right posteriorsemicircular canal BPPV treatment. Position No. 1 with its associatedridge pair opening is seen 20 degrees above the equator and 45 degreesto the right of the line of sight of the user. Position No. 2, withinthe ridge pair path, is 45 degrees to the left of the line of sight ofthe user and 20 degrees above the horizontal equator. Position No. 3 is135 degrees to the left of the line of sight of the user and 20 degreesbelow the horizontal equator. The ridge pair path opens after positionmark No. 3. FIG. 186 is a view of FIG. 185 as seen along lines 186—186thereof. In FIG. 186, the position mark No. 1 is immediately behind theposition mark No. 2 and 20 degrees above the horizontal equator. Theposition mark No. 1 is 135 degrees to the right of the user's line ofsight. Position mark No. 2 is 20 degrees above the horizontal equatorand 45 degrees to the right of the line of sight of the user. Positionmark No. 3 is 45 degrees to the left of the line of sight of the userand 20 degrees below the horizontal path.

The left posterior semicircular canal BPPV treatment configuration isshown in FIG. 187. In this Figure, position mark No. 1 is 45 degrees tothe left of the line of sight of the user and 20 degrees above thehorizontal equator. It is surrounded by a ridge pair path with anopening into the ridge pair path left of the position mark No. 1. Theposition mark No. 2 is 45 degrees to the right of the line of sight ofthe user and 20 degrees above the horizontal equator. It is surroundedby a ridge pair path. The ridge pair path leads to the position mark No.3. Position mark No. 3 is 135 degrees to the right of the line of sightof the user and 20 degrees below the horizontal equator. FIG. 188 is aview of FIG. 187 as seen along lines 188—188 thereof FIG. 188 showsposition mark No. 3, 20 degrees below the horizontal equal and 45degrees to the left of the line of sight of the user.

Rolling Ball Embodiment Method

Method for Posterior SCC BPPV Treatment

Treat right posterior SCC BPPV: The components 405, 700R will be coupledto goggles 500.

Sit on the floor and/or mat with goggles over eyes (FIG. 30).

The user is instructed to sit on the floor or on a mat and put thegoggles with the rolling ball embodiment first component 700R for rightposterior SCC BPPV treatment configuration over his eyes in such amanner that the clear sphere 700R and inner sphere 710 are clearlyvisible.

Lie supine in position No. 1 (FIG. 31).

The pillow is rolled lengthwise and placed longitudinally under thespine from C5 to L1. The user is instructed to place a pillow on the matbehind him such that the pillow will be positioned under his upperthoracic spine (not under his shoulders). He then is instructed to liebackward upon the pillow and floor. The user now is instructed to movehis head such that the inner sphere enters at 721 the ridge pair path720P and moves to position mark No. 1. He is to stay in this positionfor thirty seconds or until his dizziness resolves.

Lie supine in position No. 2 (FIG. 32).

The user then moves his head such that the inner sphere 710 rolls alongthe ridge pair path 720P from the position mark No. 1 to position markNo. 2. He is instructed to stay in this position for thirty second oruntil the dizziness resolves.

Lie on left side with head turned downward 135 degrees (FIG. 33).

The user now is instructed to roll upon his left side and simultaneouslymove his head such that the inner sphere 710 rolls along the ridge pairpath 720P from position mark No. 2 to position mark No. 3. He isinstructed to remain in this position for thirty seconds or until thedizziness resolves.

Roll into crawl position (FIG. 34).

The user is instructed to keep his head in a constant position with theinner sphere 710 at position mark No. 3 while moving from lying on leftside to a crawl position. He is instructed to remain in this positionfor thirty seconds or until any dizziness resolves.

Come up to a kneeling position (FIG. 35).

The user is instructed to raise his torso into a kneeling position andsteady himself for thirty seconds or until the dizziness resolves.

Either repeat or remove goggle. If the user was dizzy during themaneuver sequence, the user now is instructed to repeat the maneuver. Ifthere was no dizziness during the maneuver sequence, the user isinstructed to stop the maneuvers and remove the goggles.

Treat left posterior SCC BPPV: The components 405, 700L will be coupledto goggles 500.

Sit on the floor and/or mat with goggles over eyes (FIG. 36).

The user is instructed to sit on the floor or on a mat and put thegoggles with the rolling ball embodiment first component 700L FIGS. 187,188 for left posterior SCC BPPV treatment configuration over his eyes insuch a manner that the outer clear sphere 700L and inner sphere 710 areclearly visible.

Lie supine in position number 1 (FIG. 37).

The pillow is rolled lengthwise and placed longitudinally under thespine from C5 to L1. The user is instructed to place a pillow on the matbehind him such that the pillow will be positioned under his upperthoracic spine (not under his shoulders). He then is instructed to liebackward upon the pillow and floor. The user now is instructed to movehis head such that the inner sphere 710 enters at 721 the ridge pairpath 720P and moves to position mark No. 1. He is to stay in thisposition for thirty seconds or until his dizziness resolves.

Lie Supine in position number 2 (FIG. 38).

The user then moves his head such that the inner sphere 710 rolls alongthe ridge pair path from the position mark No. 1 to position mark No. 2.He is instructed to stay in this position for thirty seconds or untilthe dizziness resolves.

Lie on right side with head turned downward 135 degrees (FIG. 39)

The user now is instructed to roll upon his right side andsimultaneously move his head such that the inner sphere 710 rolls alongthe ridge pair path from position mark No. 2 to position mark No. 3. Heis instructed to remain in this position for thirty seconds or until thedizziness resolves.

Roll into crawl position (FIG. 40).

The user is instructed to keep his head in a constant position with theinner sphere 710 at position mark No. 3 while moving from lying on rightside to a crawl position. He is instructed to remain in this positionfor thirty seconds or until any dizziness resolves.

Come up to a kneeling position (FIG. 41).

The user is instructed to raise his torso into a kneeling position andsteady himself for thirty seconds or until the dizziness resolves.

Either repeat or remove goggle. If the user was dizzy during themaneuver sequence, the user now is instructed to repeat the maneuver. Ifthere was no dizziness during the maneuver sequence, the user isinstructed to stop the maneuvers and remove the goggles.

Electronic Configuration Embodiment

This device attaches to the user's head to measure or determine headposition and to give the user visual feedback about his head position orseries of head positions.

Introduction

A method of measuring three dimensions of spatial orientation isdescribed herein. The specific application is to measure the orientationof a patient's head as he/she under goes treatment for dizziness. Theprocedure is to measure gravitational acceleration to ascertain attitudeand illuminate indicators to direct the patient's head motion. Thisapparatus comprises an embedded computer, and two accelerometers, eachbeing capable of measuring two dimensions of static acceleration, and ameans of displaying motion cues to the patient. Spatial attitude ismeasured by the declination of the head and rotation about thedeclination axis.

Hardware Description

FIGS. 189A, 189B, 189C, 189D diagram the electronic circuitry used tomeasure spatial orientation and operate the Light Emitting Diodes (LED).The circuitry is partitioned into five sections labeled:

Gravity Sensors, 803 comprising sensors U1 and U2

Selection and Routing system 805,

Micro Controller 807,

Patient Display 809,

Voltage Regulator 811

Some connections between the sections are indicated by connector flags,e.g. T1CLK.

Various micro chips are referenced by “U” numbers. Chips U3 through U5and U7 are industry standard parts manufactured by several majormanufacturers, such as Motorola U4 and U5 are type 4013 D flip flops.

Gravity Sensors

Acceleration is measured in two planes XY, and YZ by accelerationsensors U1 and U2. See FIG. 191. Each sensor measures two 90 degreecomponents in the earth's gravity field. The measurements are a functionof the orientation of U1 and U2 in the earth's gravity field. AnalogDevices Inc., manufactures the ADXL202 sensor. The ADXL202 is a low cost2 axis accelerometer capable of measuring static gravity field. Threedimensional measurements are made with a pair of these sensors.

Rotation is measured in the XY plane and declination is measured in theYZ plane. See FIG. 191. The raw acceleration information for the twoplanes is referenced by Rx, Ry for the rotation plane and Dy and Dz forthe declination plane. Acceleration data are encoded in a pulse format.

FIG. 190 illustrates the format of the sensor outputs and the sequenceinvolved in interpreting the pulses. The X, Y, Z trace is typical forthe three axis and is representative of one of the Rx, Ry, Dx, Dy pulsemeasurements which will be obtained. Separate X, Y, Z traces can bedepicted for each of the Rx, Ry, Dy, Dz measurements made. Each pulseoutput is periodic over the interval T0 through T2. Acceleration isrepresented by the duration of the interval T0-T1 as a percentage of thetotal interval T0-T2. This format is commonly referred to as “dutycycle” encoding.

Acceleration=(T 1−T 0) (T 2−T 0)  (1)

The sensors are set to a T0-T2 interval of ten milliseconds. ResistorsR1 and R2 set this interval. The bandwidth of the sensor outputs islimited to 10 Hz by capacitors C1-C4. This bandwidth (response time) isadequate for the measurement of head motion.

Selection and Routing

The four Rx, Ry, Dy, Dz pulses are sequentially selected by U3 androuted to the micro controller through gates U6A and U6B. The controllerspecifies which channel is selected by inputs to S₀ and S₁ of U3.

The purpose of the routing logic is to separate the two intervals,(T₁−T₀ and T₂−T₀) and route a stream of pulses to counters contained inthe controller. Refer to FIGS. 189A, 189B, 189C, 189B and 190. Timemeasurements are accomplished by counting the precision pulses (T₁CLKand T₂CLK). The clock pulses are sourced from the ALE output of U8, anddivided by 2 by U5B, resulting in a 500 kilohertz (kHz) clock, (twomicrosecond pulse spacing).

The micro controller starts a measurement by asserting ENAB CNT. TheCOUNT flip flop is set by ENAB CNT. The T2GATE flip flop is set at thebeginning (T0) of the period and is reset at the end of the period T2 byACK. The :presence of T2GATE, and COUNT gate the 500 kHz clock into thecounter inputs, T2CLK. Simultaneously T1GATE and COUNT gate the 500 kHzclock to the T1CLK counter. When the T0-T2 interval ends, flip flop U4Bis set signaling data is ready (DAT RDY). The micro controlleracknowledges by issuing ACK which resets the gating circuitry.

A complete set of measurements requires 40 milliseconds. Processing thedata requires approximately 50 milliseconds. The display is updated atabout 10 Hz. The patient should not perceive a delay between head motionand LED feedback.

Micro Controller

Atmel manufactures the AT89S53 micro controller. This deviceincorporates an industry standard 8051 architecture, implemented withlow power CMOS technology. The device contains an 8 bit micro processor,12 Kbytes of flash memory, two counters, and four byte wide input/outputports. A 12 MegaHz crystal clocks the internal operations. A one MegaHzexternal timing pulse (ALE) is derived from the 12 MegaHz crystal.Device U5B divides the ALE pulses by two resulting in a precision 500kHz pulse stream.

The control program is stored internally in flash memory. Flash memorycan be re-programmed as opposed to “one time programmable” memories thatare “burned” into memory. The software contains the control parametersincluding angles and dwell times.

Initial conditions are set when Power is turned on R3 and C5 create aRESET pulse which causes the controller to start execution at thebeginning of the program. A procedure is selected from a set of fourprocedures by switches S2 through S5.

Diagnostic Left (DIAG L): Switch S2

Diagnostic Right (DIAG R): Switch S3

Left Post SCC BPPV Treatment (LP SCC): Switch S4

Right Post SCC BPPV Treatment (RP SCC): Switch S5

Calibration is required for the sensor inputs because each sensor hasdifferent sensitivities and offset values. A calibration procedure isperformed during the manufacturing process. The calibration constantsare embedded in the software and are referred to as OFFSET and SCALEvalues for each channel and allow the measurements made during thetreatment process to be converted into sin and cos angles of rotationand declination.

Patient Display

Five Light Emitting Diodes (LED) D1, D2, D3, D4, D5 indicate therequired motion action. Declination motion is indicated by UP and DOWN,while RIGHT and LEFT indicate the rotation motion. Dwell position isindicated by the STOP indicator. One or two LED's will always be on. Themotion indicators are arranged as shown in FIG. 192. The goggle deviceis shown in FIGS. 201-204.

Voltage Regulator

The sensor outputs are affected to the power supply voltage. A precisionregulator U7 manufactured by National Semiconductor, fixes the supplyvoltage at a constant five volt level. This device is a low power chipdesigned for battery operated equipment. Power is sourced from a small 6volt battery. Lithium cells are preferred, for weight and performancereasons. Battery life is extended by turning the unit off with S1 whennot in use.

Software Description

The objective is to lead the patient's head through four specific paths,diagnostic left and right, right post SCC BPPV treatment and left postSCC BPPV treatment, pausing where he/she dwells for a time. The path isspecified by a set of angles defining the rotation and declination paththe head is to follow as specified in Table 1, diagnosis, Table 2, rightpost SSC BPPV treatment, and Table 3, left post SCC BPPV treatment. Thecomplete process is divided into four user selectable procedures asdescribed above.

Data Structure

A path is specified by twelve pairs of angles, where each pairrepresents a marker along the selected path. Table I shows the data fortwo diagnostic procedures.

TABLE 1 Diagnostic Procedure Diagnostic Diagnostic left Diagnostic rightStep Rotation Declination Rotation Declination  1  90 90 90 90  2  94 8086 80  3  98 70 82 70  4 102 60 78 60  5 106 50 74 50  6 110 40 70 40  7114 30 66 30  8 118 20 62 20  9 122 10 58 10 10 126  0 54  0 11 130 350 50 350  12 135 340  45 340 

The last step (12), is the dwell position. The patient remains in thedwell position to allow time for the particles to reposition. Two pathsare represented in Table 1. The first path is diagnostic left where thepatient begins in a sitting position and gradually reclines whilerotating his/her head to the left to the 135 degrees position anddeclining to 340 degrees (20 degrees below horizontal). Diagnostic rightbegins in the sitting position and ends with the head right at 45degrees declining again to 340 degrees.

Tables 2 and 3 are paths for the two SCC treatment procedures. As withthe diagnostic procedure, step twelve is the dwell state for these aswell.

TABLE 2 Right Position SCC BPPV Treatment Paths Right Post SCC BPPVTreatment Position No. 1 Position No. 2 Position No. 3 Position No. 4De- De- De- De- Rota- clina- Rota- clina- Rota- clina- Rota- clina- Steption tion tion tion tion tion tion tion 1 90 90 45 340 135 340 225 340 286 80 53 340 143 340 225 351 3 82 70 61 340 151 340 225 2 4 78 60 69 340159 340 225 13 5 74 50 77 340 167 340 225 35 6 70 40 85 340 175 340 22524 7 66 30 93 340 183 340 225 35 8 62 20 101 340 191 340 225 46 9 58 10109 340 199 340 225 57 10 54 0 117 340 207 340 225 79 11 50 350 125 340215 340 270 90 12 45 340 135 340 225 340 270 90

TABLE 3 Left Position SCC BPPV Treatment Paths Left Post SCC BPPVTreatment Position No. 1 Position No. 2 Position No. 3 Position No. 4De- De- De- De- Rota- clina- Rota- clina- Rota- clina- Rota- clina- Steption tion tion tion tion tion tion tion 1 90 90 135 340 45 340 315 340 294 80 127 340 37 340 315 351 3 98 70 119 340 29 340 315 2 4 102 60 111340 21 340 315 13 5 106 50 103 340 13 340 315 35 6 110 40 95 340 5 340315 24 7 114 30 87 340 357 340 315 35 8 118 20 79 340 349 340 315 46 9122 10 71 340 341 340 315 57 10 126 0 63 340 333 340 300 79 11 130 35055 340 325 340 285 90 12 135 340 45 340 315 340 270 90

Time Considerations

Movement through a path is not timed. The patient is prompted only torotate and/or tilt the head while moving to the next dwell position.When the head reaches position 12, a thirty second dwell intervalbegins. Some persons may have difficulty maintaining a fixed position.For this reason, short term excursions outside the dwell zone are timedby the shake timer. Shake time defines an allowable time to stay out ofthe dwell zone before restarting the dwell period. Three seconds areallowed for the shake time. If shake time is exceeded the dwell time isre-started.

Math Model

The math model shown in FIG. 191 shows how angles are defined. Thedeclination angle is defined as a vector through the center of the headextending through the center of rotation for the head. When the head isin the sitting position, the declination angle is 90 degrees. At rest(supine) position (face looking up while reclining on back), thedeclination angle is 0 degrees. Tilting the head 20 degrees below the 0degrees mark, results in a declination angle of 340 degrees.

The head is rotated about the declination vector. Rotation is measuredby an angle in the XY plane, where looking up is 90 degrees, to theright is 0 degrees, and to the left is 180 degrees. As the declinationangle changes, so does the XY plane. To compute the real rotation angle,the XY plane must be referred back to a vertical plane. This isaccomplished by first determining the declination angle DECz, thencomputing a normalization factor ROT NORM to be applied to the observedX and Y vectors. This factor is computed by:

ROT NORM=1.00 cos(DECz)  (2)

Calibration and Calculation Details

FIGS. 231A-233A and 231B-233B show relative timing for three spatialorientations used to establish the calibration values for the sensor.The values measured during calibration become constants describing thespecific properties of the sensor. Each sensor has a set of uniqueconstants. The constants are stored in the computer memory and are usedto calculate the actual orientation angles for the sensor. FIGS. 234A,234B and 235A, 235B depict the sensor output for 45 degrees and 335degrees orientation. Detailed calculations will be performed for theseorientations.

Referring to FIGS. 231A and 231B, note the arrows (upper left),representing the acceleration vectors for the sensor. For thisdiscussion, it is assumed that the plane of rotation is parallel to thegravitational field, so correction for declination is not required. InFIG. 213B, the broad arrow pointing upward near the middle of the Ryline points to a reference time noted as Tos.

The objective of the calibration procedure is to measure the duty cyclefor the two angular extremes; 90 degrees and 270 degrees, and themidpoint, at 0 degrees. The duty cycle at the midpoint Tos, is used as areference for the calculations. Variations about the reference areproportional to the angular variation about the zero degree reference.The reference at zero degrees is referred to as the “offset”, somewhatanalogous to the term “basis” used in some financial calculations toevaluate the performance of an investment instrument.

For discussion, focus upon the Ry vector (FIGS. 231A, 231B), which isoriented parallel to the gravity field. At this position, the value willbe a maximum value, that is, the time from T0 to T1 is maximum. Thus,there has been established the output from the sensor associated withhighest output that can be expected, which is 100% of the gravity field.This value defines the 90 degrees sensor output.

When the sensor is rotated clockwise to a position shown in FIGS. 232A,232B, the Ry vector is normal to the gravity field. The zero degreeposition (Tos) is chosen as the reference for calculations. This meansvariations of Ry above this point are considered as movement in thecounterclockwise direction toward 90 degrees. Ry duty cycles less thanTos are considered to be movement in the clockwise direction.

The last calibration point for the Ry vector is at 270 degrees where thesensor experiences 100% negative gravitational acceleration, meaning thesensor is physically inverted. The value read at this point representsthe minimum extreme for the sensor output. Note that the duty cycle(FIGS. 233A, 233B) is now less than the reference Tos. The sensor outputis linear, so there now is enough information to calculate the sensororientation for any duty cycle.

The micro controller reads the sensors by counting a precision pulsestream that is gated by the Ry pulse. The period, or, cycle time isgated by the T2 GATE. The precision pulse stream has a rate of 500,000pulses per second. The cycle time (T0 to T2), is 0.01 second. So thereis a period measurement of 500,000×0.01 second=5000 counts. At zerodegrees, midpoint, as shown in FIGS. 232, 232B, the sensor will be near50% duty cycle, therefore the Tos output count will be 2500 counts. Thesensor output varies ±12.5% (of period) from Tos for ±90 degreeschanges, resulting in a range of ±0.125×5000, or ±625 counts. It isexpected that T1CLK will be somewhere between 1875 and 3125 counts. Theduty cycle extremes will be different for each sensor, but remainconstant for each sensor. A perfect sensor operated under theaforementioned conditions will have a set of constants such as:

Constant Value Where it came from

RyOFFSET (Tos): 2500 [Count at 0 degrees]

RyMaxCount at 90 degrees 3125 [Count at 90 degrees=2500+625]

RyMinCount at 270 degrees 1875 [Count at 270 degrees=2500−625]

The ±625 variation about 2500 (Tos) is proportional to the sine of therotation angle. The maximum value for the sine is 1.00, hence the scalefactor is calculated by scaling the 625 count span to 1 by:

RySCALE=1/625=0.0016

Calculation of an Angle

Case 1: 45 degrees

With the constants Tos and RySCALE, there can be calculated an angle fora dwell time. A 45 degrees rotation is depicted in FIGS. 234A, 234B.Note that T0 T1 time exceeds the T0-Tos time, so it is known that theangle is between 0 and 90 degrees. At 45 degrees, the output will besin(45)×RySCALE.

First it is found out what the sensor would produce at 45 degrees

Ry Count=RyOFFSET+sin(RotAngle)×RySCALE

Ry Count=2500+0.707×625

Ry Count=2942

This is the count that will be received from the sensor for Ry at 45degrees.

To convert this number into an angle, first remove the offset:

Ry=Ry−ROFFSET

Ry=2942−2500=442

Next the number is scaled to get a sine

sin(RyAngle)=442×0.016=0.707

To find the Rotation angle, take the arcsine

ROT=arcsine(0.707)=45 degrees

Case 2: 325 (−25 degrees)

At 335 degrees, the sensor will output

Ry Count=RyOFFSET+sin(ROT Angle)×RySCALE

Ry Count=2500+(−0.4226)×625=2500−264=2236 counts

Given this count from Ry, the angle can be found the by

Ry=Ry−RyOFFSET

Ry=2236−2500=−264

Scaling

Ry=−264×0.0016=−0.4224

Finding the angle

Ry=arcsine (−0.4224)=24.98°

Transposing to the reference frame (FIG. 191 Math Model)

Ry=360−25=335°

Control Flow

Refer to FIGS. 193-200 for the flow charts describing the softwareoperations. Starting with RESET at 821 in FIG. 193, the flow initializesthe system at 822 then goes into a continuous loop beginning atoperation 823 consisting of reading the switches and sensors,determining what procedure to follow, calculating the angles andoptimizing the choice of which vector to use. At 824-827 switches S2-S5(See FIG. 189C) are scanned to determine which procedure to follow.Initialization at 822 includes Clear Counters. Reset Router, DECPOS=FALSE, ROT POS=FALSE, SHAKETIMER=FALSE, ALL LED OFF, PROCEDURE=0.Each procedure is defined by a table of data that specifies a path, anddwell position.

All procedures follow the same set of rules, the difference being thedata table associated with the selected procedure. After determining thecurrent spatial orientation, a test for subsequent action is performed.If a dwell position is not detected, then the patient is directed to thenext position according to the path in the data table. If dwellconditions exist, the dwell time is monitored as well as continuedmaintenance of the position indicators.

Operation

The control loop begins at the OPERATION connector 823, FIG. 193B. Theprocedure switches are scanned. When a switch is activated, the currentprocedure is terminated, and the new one begins immediately. Raw datafor the procedure is loaded at 828-831 into the active array and thenumber of paths for the procedure is updated. The following proceduresare carried out at 828-831: Load Diag L Tables (Number of Paths=1; LoadDiag R Tables (Number of Paths=1; Load RPSCC Tables (Number of Paths=4;Load RPSCC Tables (Number of Paths=4.

At 832 the following parameters are set. Operate=True; Pathname=1;Stepnum=1; ROTMAX=ROTn+RDEL; ROTMIN=ROTn−RDEL; DECMAX=DECn+DDEL;DECMIN=DECn−DDEL wherein RDEL and DDEL are the limits of tolerance whichmay be ±3 degrees. At 833 OPERATE is tested to determine if switch,polling is to continue.

Read Accelerometers

Beginning with Read Accelerometers, raw acceleration values Rx, Ry, Dy,Dz are read at 842 by the internal counters of the micro controller. Theduty cycle for each axis is calculated at 842 by the equation (1)described previously. The axis values are converted into actualacceleration vectors using the offset and scaling constants obtained atcalibration. At 843, the sensor offset values referred to previously anddefined at R Offset and D Offset are subtracted from the pulse valuesRx, Ry, Dy, Dz and the resulting values are multiplied by the scale offactors R Scale and D Scale to allow the resulting pulse values to beconverted to sin and cos of orientation angles to obtain the orientationof the sensors in the earth's gravity field. At 844 and 845, thedeclination angles are computed from each of the declination sensors,e.g. one for the Y axis (DECy)=A COS (Dy) and one for the Z axis (DECz=ASIN (Dz), wherein A COS is the arc cos and A SIN is the arc sin. ROTxand ROTy would be identical for a perfect sensor. However, accuracy ofthe computed angles is dependent upon the orientation. In this respecteach sensor measures two components of gravity. Initially one componentis parallel to the gravity axis while the other is normal to the gravityaxis. The vector normal to gravity is most sensitive. As rotationcontinues, X sensitivity diminishes, while Y sensitivity improves.Choosing the most sensitivity vector improves overall performance.

At 844 the normalizing factor is calculated by:

At ROT NORM=1.00 COS(DECz)

This factor is used to multiply the Rx and Ry values which converts themto normal rotation. The rotation angle ROTx, is computed by taking thearc cosine of the normalized cosine vector Rx,

ROTx=A COS(Rx×ROT NORM)  (3)

Similarly, the rotation angle ROTy is computed from the vector Ry bytaking the arc sin of the normalized sin vector Ry,

ROTy=A SIN(Ry×ROT NORM)  (4)

Select R Vector

Using the X vector results ROTx, for reference, one of the two anglesolutions is selected to define the rotation angle. The choice is madeby the flow shown in FIG. 195 beginning with Select Vector 851 andcontinuing from 852-858. Accuracy for both vectors is about equal in theregions near the switch points. FIG. 196 represents a decision modelwherein the y and x components are selected between the angles shown.

Pathfinder

This segment beginning at 861 in FIGS. 197A, 197B guides the patientthrough the path specified in the data table. FIGS. 187A and 197B areconnected by 197L1. At 862, if step 12 is the current step, then a dwellposition exists, and the flow is directed to the dwell test 881.Otherwise, the rotation and declination angles are tested against themaximum and minimum limits and the appropriate LED is activated to keepthe head within the path limits. Acceptable limit conditions aresignaled by ROT OK at 867 and DEC OK 872. When both conditions aresatisfied, the step number is incremented at 874 and the guidanceprocess continues until step 12 is reached. When step 12 entered theflow is directed to the dwell test 881.

Referring again to FIGS. 197A, 197B, the rotation is tested against theminimum limit at 863 (ROT−ROTMN) and against the maximum limit at 865(ROT−ROTMAX). If rotation is below the minimum the right LED is turnedoff and the left LED is turned on at 864.

At 865 rotation is tested against the maximum limit (ROT−ROTMAX). If therotation is above the maximum, the right LED is turned on and the leftLED is turned off at 866. If the rotation is OK at 867 (ROT OK) the pathgoes to 868 where the declination is tested against the minimum limit(DEC−DECMIN). If declination is below minimum at 869, the up LED isturned on and the down LED is turned off. At 870 the declination istested against the maximum limit, (DEC−DECMAX). If the declination isabove maximum at 871, the up LED is turned off and the down LED isturned on. If the Declination is OK at 872 (DEC OK=TRUE) and theRotation is OK at 873 (ROT OK=TRUE), the path goes to the increment stepat 874 where DEC OK is set equal it False; ROT OK is set equal to False;and the Minimum and Maximum parameters are updated.

If step 12 is not reached at 862, the path goes back to operate at 823.If step 12 is reached, the path goes to Dwell Test at 881.

Dwell Test

A dwell condition exists when the rotation and declination angles fallwithin a window specified in step 12, +5°, for instance, the dwellwindow for Diagnostic left (table 1) would be

130°<Rotation<140°

335°<Declination<345°.

Referring to FIG. 198, at 882 and 884, the first two tests compare thedeclination (DEC) to the specified value, DEC (12). At 883 and 884, ifdeclination is not inside the limits DEC (12)−5 and DEC (12)+5, the UPor DOWN LED is illuminated. If both upper and lower limit conditions aremet, the UP and DOWN indicators are turned off. At 886, status bit, DECPOS, is set true to indicate the declination angle is within limits.

At 887 and 889, the rotation angle (ROT) is compared to the currentspecified angle ROT (12). At 888 and 890, the LEFT or RIGHT indicatorsare activated if ROT is not within the specified limits ROT (12)−RDELand ROTC (12)+RDEL. For example, when ROT is within limits, the LEFT andRIGHT LED are turned off, and a status bit, ROTPOS at 891, is set trueto indicate the rotation angle is within limits. The path goes to DwellTime 892.

Dwell Time

Reference is made to FIGS. 199A and 199B which are connected by 199L1.This segment of code sets and monitors the timer for dwell time. Anothertimer, referred to as the SHAKE timer is maintained to measure shortexcursions outside the window (e.g. 3 seconds). If the patient gets lostand the SHAKE timer times out, the dwell timer is reset at 899 so thecycle can be repeated until the proper dwell time is completed. TheSHAKE timer is re-started when ROTPOS or DECPOS cease to be true.

When ROTPOS and DECPOS are true, a status bit, DWELL, is set true toindicate the dwell condition has been recognized. The STOP indicator isturned on and the dwell timer is started when the dwell condition isfirst recognized.

When the dwell interval is completed as detected by the dwell time-outtest, the PATHNUM index is incremented to the next path, ROTPOS, DECPOSand DWELL are set to false and the STOP LED is turned off. If PATHNUMexceeds the pre-determined number of dwell states, then the procedure isfinished and the COMPLETE segment is entered.

Referring again to FIGS. 199A, 199B, at 893 and 895 ROTPOS and DECPOSare determined whether they are true. If both are true, the user is inthe desired position, the shake timer is reset at 897 and shaking is setequal to FALSE. If either ROT POS or DEC POS is false, the user hasmoved out of the limits for the dwell position. If this “out of limit”condition has been detected previously, the SHAKING bit is true. 894tests this bit to determine if the condition has been recognized. Ifnot, then the SHAKING bit is set to TRUE and the SHAKE TIMER is startedin 896. If the condition has been recognized, flow is directed to 898.At 898 the SHAKE timer is tested for timeout. The timer for example maytime out in 10 seconds. If it does time out, that means that the user isstill out of position for an undesired time period and the Dwell Timeris reset at 899. If the user is in a dwell state (Dwell True at 900),the Dwell timer times out at 902 and the path number is incremented at903. In addition at 903, the following parameters are set Stop LED=OFF;DEC POS=FALSE; ROTPOT=FALSE; DWELL=FALSE. At 905 a determination is madewhether the Path number is greater than the number of paths. If true,the path goes to complete 906. If not true, the path goes back tooperate 823. At 900, if the dwell state has not been detected, the pathgoes to 901 where the following parameters are set: Dwell=True;Stop=True; Start Dwell Timer, Stop LED=On. From 901 and 902 (if thedwell timer has not timed out), the path goes to 904 where the dwelltimer is incremented and the path goes to OPERATE 823.

Complete

This segment has the sole purpose of indicating a successful completionof the procedure. All five of the LED are flashed at a one secondperiod. The controller will continue in this loop until turned off, orone of the procedure buttons is activated. The procedures at 907-910 areTurn On All LED; Delay 0.5 second; Turn Off All LED; Delay 0.5 secondrespectively.

Referring to FIGS. 201-204, the goggles are identified at 921. FIG. 201illustrates the view the user will have when the goggles are in placeover his or her eyes. Member 923 depicts the system 800 of FIGS. 189A,189B, 189C, 189D. Member 925 is a battery for supplying electrical powerto the system 800. Four push button switches S2, S3, S4, and S5 areemployed to control the system 800. Member 933 is a strap for use forsecuring the goggles to a person's head with the LEDs D1-D5 in front ofone of the eyes of the person.

Electronic Embodiment Electronic Embodiment Method

Diagnostic Method

Method to Use Device.

To diagnose right posterior semicircular canal BPPV.

The user is instructed to sit on the floor and/or mat as shown in FIG.206A and put the goggles 921 over his eyes in such a manner that the LEDscreen is clearly seen.

The user is instructed to lie supine in position “R”, FIG. 205A.

The pillow is rolled lengthwise and used longitudinally under the spinefrom C5 to L1. The user is instructed to place the pillow on the matbehind him such that the pillow will be positioned under his upperthoracic spine (not under his shoulders). He is then instructed to pushthe center button S3 of the four goggle buttons. He is instructed tofollow the head direction indicated by the LED arrows 206B. The up D1and right D5 arrows will blink and the user will lie backward upon thepillow and floor. The user is to extend his neck until the up arrow D1ceases flashing and he is instructed to turn his head to the right untilthe right arrow D5 ceases flashing. When both up and right arrows ceaseflashing, the “stop” indicator will light, FIG. 205B. The user isinstructed to stay in this position until the stop indicator is nolonger lighted (for 30 seconds).

After 30 seconds in the right Dix Hallpike position, FIG. 205A the downD3 and left D4 arrows will blink FIGS. 207A, 207B. The user will situpward, flexing his neck and turning his head to the left until hereaches the sitting and forward looking position. When the user reachesthe upright position, the downward flashing arrow will cease to flashand when the head is turned straight ahead, the left pointing arrow willcease to flash and the stop indicator D2 will light up FIG. 208B. Theuser is instructed to remain in the upright sitting position while thestop indicator is lighted and wait for his dizziness to resolve FIGS.208A, 208B.

To diagnose the left posterior semicircular canal BPPV.

Lie supine in position “L”, FIG. 210A.

The user will push the button S2. The up D1 and left D4 arrows willbegin to blink, FIGS. 209A, 209B and the user will lie backward upon thepillow and floor. The user is to extend his neck until the up arrowceases flashing and he is instructed to turn his head to the left untilthe left arrow ceases flashing. When both up and left arrows ceaseflashing, the “stop” indicator will light, FIG. 210B. After 30 secondsin the left Dix Hallpike position, FIGS. 210A and 210B, the down D3 andright D5 arrows will blink, FIGS. 211A, 211B. The user will sit upward,flexing his neck and turning his head to the right until he reaches thesitting and forward looking position. When the user reaches the uprightposition, the down flashing arrow will cease to flash and when the headis turned straight ahead the right pointing arrow will cease to flashand the stop indicator will light up. The user is instructed to remainin the upright sitting position and wait for his dizziness to resolve,FIGS. 212A, 212B. He is instructed to remove the goggles, wait 30seconds or until his dizziness resolves.

The user is instructed to determine whether placing his head in theposition such that the right ear is more downward, causes more dizzinessthan placing his head in the position such that the left ear is moredownward. The ear downward position which causes the greatest symptomsof dizziness is the ear that is affected by the posterior semicircularcanal BPPV.

Method for Posterior SCC BPPV Treatment

Treat Right Posterior SCC BPPV:

Sit on the Floor and/or mat with goggles over eyes FIG. 213A.

The user is instructed to sit on the floor or on a mat and put thegoggles over his eyes in such a manner that the LED is clearly seen,FIG. 213A.

Lie supine in position number 1 (FIG. 214A).

Pillow is rolled lengthwise and placed longitudinally under the spinefrom C5 to L1. He is instructed to place a pillow on the mat behind himsuch that the pillow will be positioned under his upper thoracic spine(not under his shoulders). He is then instructed to push the right mostof buttons S5. He is instructed to follow the head direction indicatedby the LED arrows. The up D1 and right D5 arrows will blink, FIG. 213B,and the user will lie backward upon the pillow and floor. The user is toextend his neck until the up arrow ceases flashing and he is instructedto turn his head to the right until the right arrow ceases flashing.When both up and right arrows cease flashing, the “stop” indicator willlight up, FIG. 214B. The user is instructed to stay in this positionuntil the stop indicator is no longer lit (for 30 seconds), FIG. 214A.

Lie Supine in position number 2 FIG. 215A.

The user is instructed to follow the head direction indicated by the LEDarrows, FIGS. 215A, 215B. The up D1 and left D5 arrows will blink andthe user will turn his head to the left while keeping his neck extended.So long as the user keeps his neck extended enough that the head isextended equal to or more than 20 degrees below horizontal, the up arrowwill not flash. The user is to extend his neck until the up arrow ceasesflashing and he is instructed to turn his head to the left until theleft arrow ceases flashing. When both up and left arrows cease flashing,the “stop” indicator will light up, FIGS. 216A, 216B. The user isinstructed to stay in this position until the stop indicator is nolonger lit (for 30 seconds), FIGS. 217A, 217B.

Lie on left side with head turned downward 135 degrees (FIG. 218A).

The user is instructed to follow the head direction indicated by the LEDarrows, FIG. 217B. The up D1 and left D4 arrows will blink and the userwill turn his head to the left while keeping his neck extended. So longas the user keeps his neck extended enough that the head is extendedequal to or more than 20 degrees below horizontal, the up arrow will notflash. The user is to extend his neck until the up arrow ceases flashingand he is instructed to turn his head to the left until the left arrowceases flashing. In order to follow the head position instructions givenby the flashing light the user will roll onto his left side. When bothup D1 and left D4 arrows cease flashing, the “stop” indicator will lightup, FIGS. 218A, 218B. The user is instructed to stay in this positionuntil the stop indicator is no longer lit (for 30 seconds), FIG. 218A.

Roll into crawl position FIG. 219A.

The user is instructed to keep his head in the position 3, FIG. 218A androll his body toward the left side into a crawl position. The 4 LEDdirectional arrows will prompt the user what direction his head must bemoved to be kept in the constant position. He is instructed to remain inthis position for thirty seconds or until any dizziness resolves, FIG.219A.

Come up to a kneeling position FIG. 221A.

The user is instructed by the flashing up arrow FIG. 220B to raise hishead and torso into the kneeling forward looking position and steadyhimself for thirty seconds or until the dizziness resolves, FIGS. 220A,221A.

Either repeat or remove goggle. If the user was dizzy during themaneuver sequence, the user is now instructed to repeat the maneuver. Ifthere was no dizziness during the maneuver sequence, the user isinstructed to stop the maneuvers and remove the goggles.

Method for Posterior SCC BPPV Treatment

Treat Left Posterior SCC BPPV:

Sit on the Floor and/or mat with goggles over eyes FIG. 222A.

The user is instructed to sit on the floor or on a mat and put thegoggles over his eyes in such a manner that the LED is clearly seen,FIG. 222A.

Lie supine in position number 1, FIG. 223A. Pillow is rolled lengthwiseand placed longitudinally under the spine from C5 to L1. The user isinstructed to place a pillow on the mat behind him such that the pillowwill be positioned under his upper thoracic spine (not under hisshoulders). He is then instructed to push the goggle button S4. He isinstructed to follow the head direction indicated by the LED arrows. Theup D1 and left D4 arrows will blink FIG. 222B and the user will liebackward upon the pillow and floor. The user is to extend his neck untilthe up arrow ceases flashing and he is instructed to turn his head tothe left until the left arrow ceases flashing. When both up and leftarrows cease flashing, the “stop” indicator will light up, FIGS. 223A,223B. The user is instructed to stay in this position until the stopindicator is no longer lit (for 30 seconds), FIGS. 224A, 224B.

Lie Supine in position number 2 FIG. 226A.

The user is instructed to follow the head direction indicated by the LEDarrows, FIGS. 224A, 224B. The up D1 and right D5 arrows will blink andthe user will turn his head to the right while keeping his neckextended. So long as the user keeps his neck extended enough that thehead is extended equal to or more than 20 degrees below horizontal, theup arrow will not flash. The user is to extend his neck until the uparrow ceases flashing and he is instructed to turn his head to the rightuntil the right arrow ceases flashing. When both up and right arrowscease flashing, the “stop” indicator will light up, FIGS. 225A, 225B.The user is instructed to stay in this position until the stop indicatoris no longer lit (for 30 seconds), FIGS. 226A, 226B.

Lie on left side with head turned downward 135 degrees (FIG. 227A).

The user is instructed to follow the head direction indicated by the LEDarrows, FIGS. 226A, 226B. The up D1 and right D5 arrows will blink andthe user will turn his head to the right while keeping his neckextended. So long as the user keeps his neck extended enough that thehead is extended equal to or more than. 20 degrees below horizontal, theup arrow will not flash. The user is to extend his neck until the uparrow ceases flashing and he is instructed to turn his head to the rightuntil the right arrow ceases flashing. In order to follow the headposition instructions given by the flashing light, the user will rollonto this right side. When both up and right arrows cease flashing, the“stop” indicator light up,. FIGS. 227A, 227B. The user is instructed tostay in this position until the stop indicator is no longer lit (for. 30seconds).

Roll into crawl position FIG. 228A.

The user is instructed to keep his head in the position 3, FIGS. 227A,227B and roll his body toward the right side into a crawl position. The4 LED directional arrows will prompt the user what direction his headmust be moved to be kept in the constant position. He is instructed toremain this position for thirty seconds or until any dizziness resolves,FIGS. 228A, 228B.

Come up to a kneeling position FIG. 230A.

The user is instructed by the flashing up arrow (FIGS. 229A, 229B) toraise his head and torso into the kneeling forward looking position andsteady himself for thirty seconds or until the dizziness resolves, FIGS.230A, 230B.

Either repeat or remove goggle. If the user was dizzy during themaneuver sequence, the user is now instructed to repeat the maneuver. Ifthere was no dizziness during the maneuver sequence, the user isinstructed to stop the maneuvers and remove the goggles.

Referring now to FIGS. 236-258 the devices shown therein are similar tothe devices of FIGS. 1-26 but have been modified. In FIGS. 1-2 and236-258, the same reference numerals shown therein identify the samecomponents. The outer sphere 302M is the same as outer sphere 302 butthe outer sphere 302M has observer markings on its outer surface. Theinner sphere 305M is the same as the inner sphere 305 but has anobservers position bulls eye 4 as described below.

The user sighting mark 306 of FIG. 236 is on the horizontal equatordirectly in the user's line of sight in all outer sphere versions. Theouter sphere versions (302XRM, 302XLM, 302ZM) have additional outersphere markings. The posterior BPPV outer sphere configurations as shownin FIGS. 236, 237, and 238. FIG. 236 shows an outer sphere from theuser's point of view with the user's sighing mark 306 in the center ofthe user's line of sight. The observer sighting markings are all on thehorizontal equator of the outer sphere when the user is in the sittingposition. FIG. 238 shows FIGS. 236 from the point of view of arrows A—A.FIG. 238 shows a posterior BPPV outer sphere diagnostic configuration302ZM. Transparent observers sighting markers 306.5L and 306.5R areshown in FIG. 238 on the horizontal equator. Marker 306.5L is 100degrees to the right of the user's line of sight shown by the user'ssighting mark 306. The observer sighting mark 306.5R is 190 degrees tothe right of the user's line of sight.

The posterior BPPV treatment outer sphere configurations are shown inFIGS. 239 and 240. FIG. 239 shows the right posterior BPPV treatmentouter sphere configuration viewed from superiorly as seen along arrowsA—A in FIG. 236. The user sighting mark 306 is directly in the user'sline of sight shown by the upward directed arrow at the bottom of theFIG. 239. The observer's sighting marks are all on the horizontalequator. The transparent observer's sighting mark 306XR1 is 100 degreesto the left of the user's point of view. The observer's transparentsighting mark 306XR2 is 190 degrees to the left of the user's line ofsight. The observer's transparent sighting mark 306XR3 is 280 degrees tothe left of the user's line of sight. The observer sighting marks areconnected by a path 1071R. The path runs along the horizontal equator ofthe outer sphere from one observer sighting mark to the next. The path1071R should stay aligned with the position bulls eye No. 4 as the usermoves his head to move the outer sphere about the inner sphere duringthe right posterior BPPV treatment maneuver. During the right posteriorBPPV treatment maneuver, position bulls eye No. 4 of the inner sphereshould be seen by the observer within sighting mark 306XR1 (headposition #1) for 30 seconds; as movement continues, then within sightingmark 306XR2 (head position #2) for 30 seconds; and as movement continuethen within sighting mark 306XR3 (head position #3) for 30 seconds. Thepatient should then raise his torso from the crawl position to thekneeling position completing the Epley maneuver sequence.

FIG. 240 shows the left posterior BPPV treatment outer sphereconfiguration viewed from superior as seen along arrows A—A in FIG. 236.The user sighting mark 306 is directly in the user's line of sight shownby the upward directed arrow at the bottom of the FIG. 240. Theobserver's sighing marks are all on the horizontal equator. Theobserver's transparent sighting mark 306XL1 is 100 degrees to the rightof the user's point of view. The observer's transparent sighting mark306XL2 is 190 degrees to the right of the user's line of sight. Theobserver's transparent sighting mark 306XL3 is 280 degrees to the rightof the user's line of sight. The observer sighting marks are connectedby a path 1071L. The path runs along the horizontal equator of the outersphere from one observer sighting mark to the next. The path 1071Lshould stay aligned with the position bulls eye No. 4 as the user movesthis head to move the outer sphere about the inner sphere during theleft position BPPV treatment maneuver. During the left posterior BPPVtreatment maneuver, position bulls eye No. 4 of the inner sphere shouldbe seen by the observer within 306XL1 (Head position #1) for 30 seconds;as movement continues, then within sighting mark 306XL2 (head position#2) for 30 seconds; and as movement continues, within the sighting mark306XL3 (head position #3) for 30 seconds. The patient should then raisehis torso from the crawl position to the kneeling position completingthe Epley maneuver sequence.

Referring to FIGS. 241-246 and 249-256 within each outer sphere is aninner sphere 305M. The inner sphere is suspended in a liquid 303, waterin the preferred embodiment, and is buoyancy neutral. The inner spherehas a weight 320, which maintains a vertical axis 305V in a verticalposition. The inner sphere has an elongated bar magnet 390 which is apermanent magnet 390 located in the center of the sphere 305M. The axis390A of the magnet 390 is located at an angle of 20 degrees relative toa horizontal axis 305H, which is perpendicular to axis 305V. The higherend of the magnet 390 is directed toward the side 305S upon which arelocated the position bulls eye No. 1 and No. 2.

The inner sphere has a numbered series of position bulls eyes 330printed upon it and a path 315 from each position bulls eye to the nextsequentially numbered position bulls eye for bulls eye positions 1, 2,and 3. The posterior BPPV treatment inner spheres each have a bulls eyeNo. 4 which is not connected to the other bulls eyes by the path 315.There are two types of position bulls eye configurations used on theinner sphere of the embodiment. The first is a posterior BPPV treatmentconfiguration. The second is the BPPV diagnostic configuration. Theinner spheres in these two embodiments are identified by referencenumerals 305XM and 305ZM respectively.

The posterior BPPV treatment configuration is shown in FIGS. 249-256.FIG. 249 shows an inner sphere 305XM with the vertical equator 305VEupon it. FIG. 250 shows that in the right posterior SCC BPPV treatmentconfiguration from the user's line of sight, the position bulls eye No.1 is 45 degrees to the right of the user's line of sight (up pointingarrow at bottom of FIG. 250); position bulls eye No. 2 is 45 degrees tothe left of the user's line of sight; and the No. 3 position bulls eyeis 135 degrees to the left of the user's line of sight. The No. 4position bulls eye is 215 degrees to the left of the user's line ofsight. As seen in FIG. 251 bulls eyes No. 1 and No. 2 are 20 degreesfrom the vertical equator, and No. 3 and No. 4 are 20 degrees from thevertical equator, but in the opposite direction. These angles aredetermined by the equator and straight lines extended from the center ofthe inner sphere 305XM to the position bulls eyes No. 1, Nos. 2, No. 3,and No. 4. FIG. 252 illustrates the position bulls eyes No. 1, No. 2,No. 3 and No. 4 for the right posterior SCC BPPV treatment from theperspective of FIG. 249. FIG. 253 is a view of FIG. 252 as seen alonglines 253—253 thereof. FIG. 253 illustrates the position bulls eyes No.1, No. 2, No. 3, and No. 4 for the right posterior SCC BPPV treatmentconfiguration. The inner sphere of FIGS. 252 and 253 for use for theright posterior SCC BPPV treatment is identified at 305XRM.

FIGS. 254 and 255 show the location of position bulls eyes No. 1, No. 2,No. 3, and No. 4 for the left posterior SCC BPPV treatmentconfiguration. FIG. 254 illustrates the position bulls eye No. 1, No. 2,No. 3, and No. 4 for the left posterior SCC BPPV treatment configurationfrom the perspective of FIG. 249. FIG. 255 is a view of FIG. 254 as seenfrom lines 255—255 thereof and illustrates the position bulls eyes No.1, No. 2, No. 3, and No. 4 for the left posterior SCC BPPV treatmentconfiguration. The inner sphere of FIGS. 254 and 255 for use for theright posterior SCC BPPV treatment is identified at 305XLM.

The third position bulls eye configuration is the diagnosticconfiguration of FIGS. 257 and 258. These bulls eyes are located on aninner sphere 305ZM. Positions bulls eye “R” is in the same position asthe right posterior SCC BPPV treatment position bulls eye No. 1, FIGS.254 and 255. Position bull eye “L” is in the same position as the leftposterior SCC BPPV treatment position bulls eye No. 2, FIGS. 254 and255. Position bulls eye No. 4 is in the same position as position as theleft posterior SCC BPPV treatment position bulls eye No. 4 FIGS. 254 and255.

The device 400 for holding the modified sphere 305M of component 300 atthe appropriate focal distance from the lens 410 is identified at 400 inFIG. 244 and is the same as the device of FIG. 6. The modification ofthe device 400 which includes the external magnet 215 is shown in FIGS.245 and 246 and is the same as the device of FIGS. 7 and 8. The thirdcomponent 500 which holds the combination of the second component 400and the first component 300 in the front of the eye of the user is shownin FIGS. 247 and 248 and is the same as that shown in FIGS. 9 and 10.

For diagnostic purposes the outer sphere 302ZM will have the diagnosticinner sphere 305ZM located therein supported by the liquid 303. Fortreatment purposes, two outer spheres 302XLM and 302XRM will beprovided, 302XLM having located therein the inner sphere 305XLMsupported by the liquid 303; 302XRM having located therein the innersphere 305XRM supported by the liquid 303. Each component 500 has twoeye openings 500L and 500R for the left and right eyes. Each spherecombination (302ZM, 305ZM), (302XLM, 305XLM), (302XRM, 305XRM) will beseparately coupled to a component 400 to form three different componentcombinations 400 (302ZM, 305ZM), 400 (302XLM, 305XLM), 400 (302XRM,305XRM) each of which may be removably coupled to the left or rightopenings 500L or 500R of the goggles 500.

METHOD TO USE DEVICE

To diagnose right and left posterior semicircular canal BPPV. The useris instructed to follow the following procedure.

The user is instructed to sit on the floor and/or mat and put thegoggles over his eyes in such a manner that the outer clear watertightsphere sighting mark 306 is clearly seen, as shown in FIG. 27. Thediagnostic first component combination 400 (302ZM, 305ZM) is in placecoupled to the desired eye opening of the goggles 500.

The user is instructed to lie supine in position “R”, FIG. 28.

The pillow is rolled lengthwise and used longitudinally under the spinefrom C5 to L1. He is instructed to place the pillow on the mat behindhim such that the pillow will be positioned under his upper thoracicspine (not under his shoulders). He is then instructed to lie backwardupon the pillow and floor. The user is now instructed to find thepositioning bulls eye “R”, FIG. 257, 268, and position it within theuser sighting mark 306. The observer looks at the surface of the outersphere 302ZM at the observer sighting mark 306.5R. If the bulls eye No.4 is not in the center of the sighting mark 306.5R the observer is tocoach the user to attain the correct head position. He is to stay inthis position for 30 seconds or until his dizziness resolves.

Sit on the floor and/or mat with goggles over the eyes, FIG. 27.

The user is instructed to return to the upright sitting position andwait for his dizziness to resolve.

Lie supine in position “L”, FIG. 29.

The pillow is rolled lengthwise and placed longitudinally under thespine from C5 to L1. The user is instructed to place the pillow on themat behind him such that the pillow will be positioned under his upperthoracic spine (not under his shoulders). He is instructed to liebackward upon the pillow and floor. The user is now instructed to findthe position bulls eye “L” (FIGS. 25, 26) and position it within theuser sighting marker 306. The observer looks at the surface of the outersphere 302ZM at the observer sighting mark 306.51. If the bulls eye No.4 is not in the center of the sighting mark 306.51 the observer is tocoach the user to attain the correct head position. He is to stay inthis position for 30 seconds or until his dizziness resolves.

Return to the sitting position, FIG. 27.

The user is instructed to sit upright. He is instructed to remove thegoggles, wait 30 seconds or until his dizziness resolves. The user isinstructed to determine whether placing his head in the position suchthat “R” is within the user sighting marking causes more dizziness thanplacing his head in the position such that “L” is within the usersighting mark. The position which causes the greatest symptoms ofdizziness is the ear that is affected by the posterior semicircularcanal BPPV.

METHOD FOR POSTERIOR SCC BPPV TREATMENT

Treat Right Posterior SCC BPPV:

Sit on the floor and/or mat with goggles over eyes (FIG. 30) using thecomponent combination 400 (302XRM, 305XRM).

The user is instructed to sit on the floor or on a mat and put thegoggles over his eyes in such a manner that the outer clear watertightball user sighting mark 306 is clearly seen.

Lie supine in head position No. 1 (FIG. 31).

The pillow is rolled lengthwise and placed longitudinally under thespine from C5 to L1. The user is instructed to place a pillow on the matbehind him such that the pillow will be positioned under his upperthoracic spine (not under his shoulders). He then is instructed to liebackward upon the pillow and floor. The user is now instructed to findthe positioning bulls eye No. 1 (FIGS. 252, 253) and position it withinthe user sighting marker 306 (head position No. 1). The observer is tonote if the inner sphere position bulls eye No. 4 is in the center ofthe observer sighting mark 306XR1. If not, the observer is to coach theuser to attain the correct head position. The user is to stay in thisposition for thirty seconds or until his dizziness resolves.

Lie supine in head position No. 2 (FIG. 32).

The user then moves his head such that the printed path 315 on the innersphere is kept within the user sighting marking 306 and he moves hishead until the No. 2 positioning bulls eye (FIG. 255) is seen within theuser sighting marking 306 (head position no. 2). The observer is to noteif the inner sphere position bulls eye No. 4 stays in the outer spherepath 1071R from 306XR1 to 306XR2. The observer is to note if innersphere position bulls eye No. 4 is in the center of the observersighting mark 306XR2. If not the observer is to coach the user to attainthe correct head position. The user is instructed to stay in thisposition for thirty seconds or until the dizziness resolves.

Lie on left side with head turned downward 135 degrees (FIG. 33) (headposition No. 3).

He now is instructed to roll upon his left side and simultaneouslyfollow the printed path 315 within the user sighting marking 306 to thepositioning bulls eye No.: 3 (FIGS. 254, 255) (head position No. 3). Theobserver is to note if the inner sphere position bulls eye No. 4 staysin the outer sphere path 1071R from 306XR2 to 306XR3. The observer is tonote if inner sphere position bulls eye No. 4 is in the center of theobserver sighting mark 306XR3. The user is instructed to remain in thisposition for thirty second or until the dizziness resolves.

Roll into crawl position (FIG. 34).

The user is instructed to keep his head in the head position 3 (FIGS.254, 255) and roll toward the left side into a crawl position as shownin FIG. 34. The observer is to note if inner sphere position bulls eyeNo. 4 stays in the center of the observer sighting mark 306XR3 as theuser rolls into the crawl position. The user is instructed to remain inthis position for thirty second or until any dizziness resolves.

Come up to a kneeling position (FIG. 35).

The user is instructed to raise his torso into a kneeling position andsteady himself for thirty seconds or until the dizziness resolves.

Either repeat the procedure or remove the goggles. If the user was dizzyduring the positioning sequence, the user now is instructed to repeatthe maneuver. If there was no dizziness during the maneuver sequence,the user is instructed to stop the maneuvers and remove the goggles.

Treat Left Posterior SCC BPPV:

Sit on the floor and/or mat with goggles over eyes (FIG. 36) using thecomponent 400 (302XLM, 305XLM).

The user is instructed to sit on the floor or on a mat and put thegoggles over his eyes in such a manner that the outer clear watertightball user sighting mark is clearly seen.

Lie supine in head position No. 1 (FIG. 37).

The pillow is rolled lengthwise and place longitudinally under the spinefrom C5 to L1. The user is instructed to place a pillow on the matbehind him such that the pillow will be positioned under his upperthoracic spine (not under his shoulders). He then is instructed to liebackward upon the pillow and floor. The user now is instructed to findthe positioning bulls eye No. 1 (FIGS. 254, 255) and position it withinthe user sighting marker (head position No. 1). The observer is to noteif the inner sphere position bull eye No. 4 is in the center of theobserver sighting mark 306XL1. If not the observer is to coach the userto attain the correct head position. The user is to stay in thisposition for thirty seconds or until his dizziness resolves.

Lie supine in head position No. 2 (FIG. 38).

The user then moves his head such that the printed path 315 on the innersphere is kept within the user sighting marking 306 and he moves hishead until the No. 2 positioning bulls eye (FIGS. 252, 253) is seenwithin the user sighting marking (head position No. 2). The observer isto note if the inner sphere position bulls eye No. 4 stays in the outersphere path 1071L from 306XL1 to 306XL2. The observer is to note ifinner sphere position bulls eye No. 4 is in the center of the observersighting mark 306XL2. If not the observer is to coach the user to attainthe correct head position. The user is instructed to stay in thisposition for thirty seconds or until the dizziness resolves.

Lie on right side with head turned downward 135 degrees (FIG. 39). Headposition No. 3.

The user now is instructed to roll upon his right side simultaneouslyfollow the printed path 315 within the user sighting marking 306 to thepositioning bulls eye No. 3 (FIGS. 254, 255) (head position No. 3). Theobserver is to note if the inner sphere-position bulls eye No. 4 staysin the outer sphere path 1071L from 306XL2 to 306XL3. The observer is tonote if inner sphere position bulls eye No. 4 is in the center of theobserver sighting mark 306XL3. If not the observer is to coach the userto obtain the correct head position. The user is instructed to remain inthis position for thirty seconds or until the dizziness resolves.

Roll into crawl position (FIG. 40).

The user is instructed to keep his head in the head position No. 3(FIGS. 254, 255) and roll toward the right side into a crawl position,as shown in FIG. 40. The observer is to note if the inner sphereposition bulls eye No. 4 stays in the center of the observer sightingmark 306XL3 as the user rolls into the crawl position. The user isinstructed to remain in this position for thirty seconds or until anydizziness resolves, as shown in FIG. 40.

Come up to a kneeling position (FIG. 41).

The user is instructed to raise his torso into a kneeling position andsteady himself for thirty seconds or until the dizziness resolves.

Either repeat the procedure or remove the goggles. If the user was dizzyduring the positioning sequence, the user is now instructed to repeatthe maneuver. If there was no dizziness during the positioning sequence,the user is instructed to stop the maneuvers and remove the goggles.

Referring now to FIG. 259, there will be described a monitor system ofthe system of FIGS. 189A, 189B, 189C, and 189D. The LED's D1, D2, D3,D4, and D5 are the same as those of FIGS. 189D and 201 which are mountedon the goggles 921 of FIGS. 201. Switches S1, S2, S3, S4, S5 will beprovided in the leads L1, L2, L3, L4, and L5 respectively. Also providedare LED's D1M, D2M, D3M, D4M, and D5M which are coupled in parallel toLED's D1, D2, D3, D4, and D5 respectively by flexible leads L1M, L2M,L3M, L4M, and L5M. Thus when either one of D1, D2, D3, D4, D5 is on oroff the parallel D1M, D2M, D3M, D4M, D5M will be on or off also. TheLED's D1M, D2M, D3M, D4M, D5M are mounted on a support 1081 which may besupported on a desk or table for a care provider such as a physician orparamedic to monitor. The leads L1M, L2M, L3M, L4M, and L5M will beflexible and long enough such that they will not interfere with the headmovement of the patient while the patient is carrying out the desirehead movement. Leads L1M, L2M, L3M, L4M, and L5M have switches S1M, S2M,S3M, S4M, and S5M coupled therein. If switches S1, S2, S3, S4, S5 andS1M, S2M, S3M, S4M, S5M are closed, there will be feedback informationto the patient and the same information presented to the care providerwhen the patient is performing the head maneuver. Thus the care providercan help the patient correctly perform the head positioning maneuvers.If switches S1, S2, S3, S4, S5 are closed and switches S1M, S2M, S3M,S4M, S5M are open, feedback information will be provided only to thepatient. If switches S1, S2, S3, S4, S5 are open and switches S1M, S2M,S3M, S4M, S5M are closed, head positioning information will be providedonly to the care provider whereby the care provider can monitor andinstruct the patient in carrying out the positioning maneuvers.

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I claim:
 1. A method of performing a statistical determination as towhether a person has benign paroxysmal positional vertigo of any of thesemicircular canals based upon answers provided by a person to questionsstored in a central computer systems located at a distance spaced fromsaid person comprising the steps of: carrying out communication by saidperson to access said central computer system to obtain said questionsstored in said central computer system, communicating said questions tosaid person, answering said questions and communicating said answeredquestions to said central computer system, evaluating the answers tosaid questions and determining the percentage chance that said personhas benign paroxysmal positional vertigo of any of the semicircularcanals, communicating to said person, the percentage chance that saidperson has benign paroxysmal positional vertigo which would beresponsive to canalith repositioning maneuvers directed to any of thesemicircular canals, if it is determined that said person would beresponsive to canalith repositioning maneuvers, based on said percentagechance, communicating to said person an offer to sell to said person anapparatus which will guide the head positioning of said person to allowthe diagnosis of which membranous semicircular canal is involved if saidanswers do not indicate the involved membranous canal.
 2. A method ofperforming a statistical determination as to whether a person has benignparoxysmal positional vertigo of any of the semicircular canals basedupon answers provided by a person to questions stored in a centralcomputer systems located at a distance spaced from said personcomprising the steps of: carrying out communication by said person toaccess said central computer system to obtain said questions stored insaid central computer system, communicating said questions to saidperson, answering said questions and communicating said answeredquestions to said central computer system, evaluating the answers tosaid questions and determining the percentage chance that said personhas benign paroxysmal positional vertigo of any of the semicircularcanals, communicating to said person, the percentage chance that saidperson has benign paroxysmal positional vertigo, which would beresponsive to canalith repositioning maneuvers directed to any of thesemicircular canals, if it is determined that said person would beresponsive to canalith repositioning maneuvers, based on said percentagechance, communicating to said person an offer to sell to said person anapparatus which will guide the head positioning of said person throughcanalith repositioning maneuvers directed to the removal of otoconiafrom the involved membranous semicircular canal.
 3. A method ofperforming a statistical determination as to whether a person has benignparoxysmal positional vertigo of any of the semicircular canals basedupon answers provided by a person to questions stored in a centralcomputer systems located at a distance spaced from said personcomprising the steps of: carrying out communication by said person toaccess said central computer system to obtain said questions stored insaid central computer system, communicating said questions to saidperson, answering said questions and communicating said answeredquestions to said central computer system, evaluating the answers tosaid questions and determining the percentage chance that said personhas benign paroxysmal positional vertigo of any of the semicircularcanals, communicating to said person, the percentage chance that saidperson has benign paroxysmal positional vertigo which would beresponsive to canalith repositioning maneuvers directed to any of thesemicircular canals, if it is determined that said person would beresponsive to canalith repositioning maneuvers, based on said percentagechance, communicating to said person an offer to sell to said person anapparatus which will guide the head positioning of said person to allowthe diagnosis of which membranous semicircular canal is involved if saidanswers do not indicate the involved membranous canal and an apparatuswhich will guide the head of said person through canalith repositioningmaneuvers directed to the removal of otoconia from the involvedmembranous semicircular canal.
 4. The method of claim 1, wherein: ifsaid person wishes to purchase said apparatus, arranging for payment ofsaid apparatus by said person and arranging for the shipment of saidapparatus to said person.
 5. The method of claim 2, wherein: if saidperson wishes to purchase said apparatus, arranging for payment of saidapparatus by said person and arranging for the shipment of saidapparatus to said person.
 6. The method of claim 3, wherein: if saidperson wishes to purchase said apparatus, arranging for payment of saidapparatus by said person and arranging for the shipment of saidapparatus to said person.
 7. The method of any of claims 1, 2, 3, 4, 5,or 6, wherein: said person has access to a user computer wherein, saidcommunications by said person with said central computer system arecarried out with the aid of said user computer.
 8. The method of any ofclaims 4, 5, or 6, wherein: said person has access to a user computerwherein, said communications by said person with said central computersystem are carried out with the aid of said user computer, arrangementsfor payment of said apparatus by said person and arrangements forshipment of said apparatus to said person are carried with the aid of adistributor computer.
 9. The method of any of claims 1, 2, 3, 4, 5, or6, wherein: said person has access to a user computer wherein saidcommunications by said person with said central computer system arecarried out with the aid of said user computer and said communicationsbetween said user computer and said central computer system are carriedout by the use of internet connections.
 10. A system for performing astatistical determination of the percentage chance as to whether aperson has benign paroxysmal positional vertigo of any of thesemicircular canals, comprising: a computer having a storage system, acomputer program stored in said storage system including a series ofquestions pertinent to benign paroxysmal positional vertigo and whichare accessible by a person and which are to be answered by a person,said computer program includes means for analyzing the answers providedby the person and for communicating to the person the percentage- chancethat the person has benign paroxysmal positional vertigo, and anapparatus which will guide the head positioning of said person to allowthe diagnosis of which membranous semicircular canal is involved if saidanswers do not indicate the involved membranous canal.
 11. The system ofclaim 10, wherein said apparatus comprises: a hollow outer housinghaving a sighting mark thereon, an inner member and a liquid located insaid outer housing with said liquid supporting said inner member suchthat said outer housing can move relative said inner member, a leftindicia and a right indicia formed on said inner member at spaced apartpositions, a support means having first and second opposite ends, saidsecond end of said support means being coupled to said outer housingsuch that said sighting mark can be seen from said first end of saidsupport means, means for coupling said support means to a persons headnext to an eye of the person to allow the person to see said sightingmark and to move said outer housing with the persons head to allow theperson to see each of said indicia at different positions of theperson's head.
 12. A system for performing a statistical determinationof the percentage chance as to whether a person has benign paroxysmalpositional vertigo of any of the semicircular canals, comprising: acomputer having a storage system, a computer program stored in saidstorage system including a series of questions pertinent to benignparoxysmal positional vertigo and which are accessible by a person andwhich are to be answered by a person, said computer program includesmeans for analyzing the answers provided by the person and forcommunicating to the person the percentage chance that the person hasbenign paroxysmal positional vertigo, and an apparatus which will guidethe head positioning of said person to allow the resolution of benignparoxysmal positional vertigo.
 13. The system of claim 10, comprising:an apparatus which will guide the head of said person through canalithrepositioning maneuvers directed to the removal of otoconia from theinvolved membranous semi-circular canal.
 14. A system for performing astatistical determination of the percentage chance as to whether aperson has benign paroxysmal positional vertigo of any of thesemicircular canals, comprising: a computer having a storage system, acomputer program stored in said storage system including a series ofquestions pertinent to benign paroxysmal positional vertigo and whichare accessible by a person and which are to be answered by a person,said computer program includes means for analyzing the answers providedby the person and for communicating to the person the percentage chancethat the person has benign paroxysmal positional vertigo, and anapparatus which will guide the head of said person through canalithrepositioning maneuvers directed to the removal of otoconia from theinvolved membranous semi-circular canal.